Table 7 Relevance of different VTE risk factors and recommendations for prescribing contraceptives; adapted from the UKMEC.
| Risk factor for VTE | Relevance for VTE risk when taking hormonal contraceptives | Recommended actions |
|---|---|---|
| # According to the 2015 World Health Organization (WHO) guideline, patients with no thrombophilia but with a positive familial history of thrombophilia may take COC. | ||
| Age > 35 years | low – moderate | Provide extensive advice about risks; in principle, all forms of contraception are possible |
| BMI > 35 kg/m 2 | low – moderate | Provide extensive advice about risks; taking COC should be avoided if possible |
| Smoking (cigarettes) | low – moderate | Provide extensive advice about risks; taking COC should be avoided if possible (particularly if older than 35 years and/or smoking > 15 cig./day) |
≥ 2 of the risk factors listed below
|
moderate – high | Provide extensive advice about risks; taking COC should be avoided if possible |
| Prolonged immobility, major surgical procedure | moderate – high | Provide extensive advice about risks; patient should not be started on COC; consistent thrombosis prophylaxis prescribed for COC users |
| Patient has previous history of VTE | moderate (triggered VTE) to high (unprovoked or hormone-related VTE) |
Taking COC should be avoided; consider consulting a hemostaseology specialist (if consulted, the specialist should test for thrombophilia) |
| Familial history positive for VTE, with VTE occurring in first-degree relatives below the age of 45 | moderate (triggered VTE) to high (idiopathic or hormone-related VTE) |
Taking COC # should be avoided; consider consulting a hemostaseology specialist (if consulted, the specialist should test for thrombophilia) |
| Familial history positive for VTE, with VTE occurring in first-degree relatives above the age of 45 | low – moderate | Provide extensive advice about risks; taking COC is possible # if no suitable alternatives are available |
| Asymptomatic thrombophilia or thrombophilia reported in first-degree relatives |
low – high depending on the type of thrombophilia and its manifestation in the family |
Testing for thrombophilia is indicated and critically important for asymptomatic patients; if thrombophilia is proven, consult with a hemostaseology specialist before starting hormonal contraception |