From the Guidelines
Nexplanon (Etonogestrel) is contraindicated in patients with a history of thrombosis or thromboembolic disorders, as well as those with antiphospholipid antibody-positive patients, due to the potential increased risk of thrombosis. The primary concern with Nexplanon is its potential to increase the risk of thrombosis, particularly in patients with a history of thrombosis or thromboembolic disorders 1.
Key Considerations
- Antiphospholipid antibody-positive patients should avoid Nexplanon due to the increased risk of thrombosis 1.
- The risk of venous thromboembolism (VTE) is a significant concern with hormonal contraceptives, and Nexplanon may not be suitable for patients with a high risk of VTE 1.
- Patients with a history of deep vein thrombosis or pulmonary embolism should not use Nexplanon due to the increased risk of recurrent thrombosis 1.
Important Details
- The American College of Rheumatology recommends against the use of combined estrogen-progestin contraceptives in women with positive antiphospholipid antibodies due to the increased risk of thromboembolism 1.
- Progestin-only contraceptives, such as Nexplanon, may be considered a lower-risk option for patients with antiphospholipid antibodies, but the evidence is limited, and caution is advised 1.
- A thorough medical history and risk assessment should be conducted before prescribing Nexplanon to ensure that the benefits outweigh the risks 1.
From the Research
Contraindications for Nexplanon (Etonogestrel)
- Current or past thrombosis or thromboembolic disorders, as the risk of thrombosis is increased with the use of hormonal contraceptives, including etonogestrel 2
- Liver tumors or active liver disease, as estrogen-containing contraceptives are contraindicated in patients with acute liver disease, and although Nexplanon is a progestin-only contraceptive, caution is advised in patients with liver disease 3
- Undiagnosed abnormal vaginal bleeding, as the use of hormonal contraceptives may mask the diagnosis of underlying conditions 3
- Known or suspected breast cancer, as the safety of Nexplanon in patients with breast cancer has not been established 4
- Known or suspected pregnancy, as Nexplanon is not intended for use during pregnancy 3
Warnings and Precautions
- Nexplanon should be used with caution in patients with a history of venous thromboembolic events, as the risk of recurrence may be increased 2, 5
- Patients with a history of liver disease should be monitored closely while using Nexplanon, as the effects of progestin-only contraceptives on the liver are not well established 3
- Nexplanon may not be suitable for patients with certain types of hormone-dependent gynaecological disorders, such as polycystic ovary syndrome (PCOS) or endometriosis, as the use of hormonal contraceptives may affect the severity of these conditions 5