How would you counsel a woman with a strong family history of thrombosis about oral contraceptives?

Would you recommend avoiding estrogen-containing OCPs? Would you test for APLS to evaluate for additional thrombotic risk factors? While not hereditary, would a family history of APLS change your decision?

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Would you advise against COC in a woman with unexplained strong family history of VTE?

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Hematology · Mayo Clinic

Answered on

This can be a complex question for which there are likely no specific data or guidelines upon which to base a recommendation. ASH has published guidelines on thrombophilia testing in VTE (Middeldorp et al., PMID 37195076). They specifically recommend against testing prior to COC prescription. The ra...

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Rheumatology · University of Chicago

Answered on

First, does she have a rheumatic diagnosis? If not, she would have the same risk of thrombosis using combined hormonal contraceptives as any other patient.

The US CDC MEC, updated in 2024, makes no indication for choosing contraception based on family history.

This patient, however, may deserve a work...

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