The influence of hormonal contraceptives on the development of ischemic stroke and other thromboembolic phenomena

Abstract

Objective: To collect the main evidence regarding an increased risk of ischaemic stroke and other thromboembolic events related to the use of hormonal contraceptives. Bibliographic review: Ethinylestradiol is related to an increase in procoagulant factors and a reduction in natural inhibitors of coagulation, while it is believed that the effects of progestagens are more discreet and variable. The transdermal application of contraceptives may result in higher risk of stroke, however some studies are contradictory; other routes of administration were not linked with any risk increase. There is evidence that the risk of stroke is higher in the first 3 months of contraceptive usage, but there is no risk increase for previous use. The main factors that increase the risk of stroke when associated with use of hormonal contraception were hyperlipidemia, tabagism and migraine with aura. Final considerations: Ethinylestradiol has a main role in establishing increased risk of stroke related to hormonal contraception, and the influence of factors such as hyperlipidemia and tabagism is well consolidated. However, more studies are needed regarding the influence of progestagens and the different routes of administration in the risk of thromboembolic events.