Should oral contraception be discontinued in patients who have developed superficial venous thrombosis (SVT) following central catheter (central line) insertion?

From the Guidelines

Discontinuation of oral contraception is recommended in patients who have developed superficial venous thrombosis (SVT) following central catheter insertion due to the increased risk of thrombotic events associated with combined hormonal contraceptives. This recommendation is based on the guidelines provided by the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 1, which categorizes the risk of thrombosis associated with combined hormonal contraceptives. Although the guidelines do not specifically address SVT following central catheter insertion, they do provide guidance on the risk of thrombosis associated with combined hormonal contraceptives in patients with a history of thrombotic events.

When a patient has already demonstrated a thrombotic tendency, even if it was related to a catheter, continuing estrogen-containing contraceptives may further increase their risk of developing more serious thrombotic complications, including deep vein thrombosis or pulmonary embolism. The guidelines classify the risk of thrombosis as a category 4 condition, indicating that the risk of thrombosis outweighs the benefits of using combined hormonal contraceptives 1.

Some key points to consider when making this decision include:

• The patient's specific risk factors for thrombosis, such as a history of thrombotic events or known thrombogenic mutations
• The extent of the thrombosis and whether other prothrombotic conditions are present
• Alternative contraceptive methods, such as progestin-only pills, intrauterine devices (hormonal or copper), implants, or barrier methods, which may be safer options for patients at increased risk of thrombosis
• The importance of individualizing the decision based on the patient's specific situation and consulting with a hematologist if necessary to assess the overall thrombotic risk before making a final decision about contraceptive options.

From the Research

Discontinuation of Oral Contraception in Patients with Superficial Venous Thrombosis

• The decision to discontinue oral contraception in patients who have developed superficial venous thrombosis (SVT) following central catheter insertion should be based on individual risk factors and medical history 2, 3.
• Studies have shown that oral contraceptive use is associated with an increased risk of venous thrombosis, including SVT 3, 4.
• The risk of venous thrombosis is highest in the first year of oral contraceptive use and in women with genetic or acquired risk factors for thrombosis 3.
• Discontinuation of oral contraception may be considered in patients who have developed SVT, especially if they have other risk factors for thrombosis 2, 3.

Management of Superficial Venous Thrombosis

• The management of SVT typically involves conservative treatment, including non-steroidal anti-inflammatory drugs, vasoprotective agents, and aspirin 2, 5.
• Anticoagulant therapy may also be considered in some cases, especially if there is a high risk of deep vein thrombosis or pulmonary embolism 5, 6.
• The treatment of choice for SVT is therapeutic or intermediate dose low molecular weight heparin or prophylactic dose fondaparinux administered for 4-6 weeks 5.

Risk Factors for Venous Thrombosis

• Oral contraceptive use is a significant risk factor for venous thrombosis, especially in women with other risk factors such as smoking, hypertension, and diabetes 3, 4.
• The type and dose of oral contraceptive used can also affect the risk of venous thrombosis, with higher doses of estrogen and certain types of progestin associated with a higher risk 3, 4.
• Central venous catheter insertion is also a risk factor for venous thrombosis, especially in patients with multiple risk factors for thrombosis 6.