Screening for activated protein C resistance before oral contraceptive treatment: A pilot study

The feasibility and cost-effectiveness of screening women for congenital th rombophilic alterations before oral contraceptive (OC) treatment was invest igated. A total of 525 women (mean age 21.9 years, 73% aged <25 years) were examined before their first OC course. At first screening, completely norm al results were recorded in 485 (92.4%) women, the remaining showing single (n = 34) or multiple (n = 6) alterations. At second examination (possible in 37 of 40), activated protein C resistance (APCR) was confirmed in 21 cas es (4.0%, 18 with factor V Leiden), protein C, or protein S reduction in 8 (1.5%) and 2 (0.4%) cases, respectively. No cases with antithrombin III def iciency were detected. The global estimated cost ($US) to detect one altere d case was: $7795 for protein S, $2696 for antithrombin III (no case found) , $1374 for protein C and $433 for APCR. The present study confirms that ex tensive thrombophilic screening before OC treatment is not currently advisa ble. APCR assessment, however, seems to have a favorable cost-effectiveness ratio: the alteration is frequent and has a synergistic effect with OC; se nsibility and specificity of some methods are good; family history is unrel iable to single out possible carriers; finally, carriers can be fully infor med of their increased thrombotic risk if treated with OC and can receive t hromboprophylaxis during life situations associated with high thrombotic ri sk (eg, pregnancy and puerperium). CONTRACEPTION 1999;59: 293-299 (C) 1999 Elsevier Science Inc. All rights reserved.