Cerebral Venous Sinus Thrombosis Occurring During Estetrol/Drospirenone Combined Oral Contraceptive Use in a Woman With Multiple Thrombotic Risk Factors: A Case Report
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A woman with multiple thrombotic risk factors including severe anemia developed cerebral venous sinus thrombosis while using estetrol/drospirenone combined oral contraceptives, highlighting persistent thrombotic risk.
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Abstract
Estetrol/drospirenone (E4/DRSP) is a combined oral contraceptive noted for its minimal hemostatic impact compared to ethinyl estradiol-based preparations. However, real-world thrombotic risk data in patients with significant comorbidities remain limited. A woman in her early 40s with adenomyosis and menorrhagia was prescribed E4/DRSP. Six weeks later, she developed acute left upper extremity weakness; imaging confirmed superior sagittal sinus thrombosis. She had severe iron deficiency anemia (hemoglobin 6.4 g/dL). Multiple overlapping risk factors-including severe iron deficiency anemia with reactive thrombocytosis, adenomyosis, obesity, hypertension, and age over 40-likely contributed synergistically, and the independent contribution of E4/DRSP cannot be determined. She was treated with anticoagulation and transitioned to relugolix for adenomyosis management. Although E4/DRSP has a favorable coagulation profile, thrombotic risk persists in women with adenomyosis and severe anemia. Pre-prescription assessment including correction of anemia and consideration of estrogen-free alternatives is warranted.
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Too few in-corpus citations on either side for a chart; here are the lists.
Cites (4)
- Long-term dienogest administration in patients with symptomatic adenomyosis 2018
- "Recurrent multiple cerebral infarctions related to the progression of adenomyosis: a case report" 2018
- Cerebral dural sinus thrombosis associated with adenomyosis: a case report 2014
- Anemia-Associated Platelets and Plasma Prothrombin Time Increase in Patients with Adenomyosis 2022
References (14)
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- Cerebral dural sinus thrombosis associated with adenomyosis: a case report via openalex
- Long-term dienogest administration in patients with symptomatic adenomyosis via openalex
- "Recurrent multiple cerebral infarctions related to the progression of adenomyosis: a case report" via openalex
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SciLite annotations
chemicals 6
estetrol
drospirenone
estetrol
drospirenone
estradiol
estrogen
organisms 1
noordeloos 2009062
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