The Preoperative Management of Oral Contraceptive Pills in Aesthetic Plastic Surgery Practice in Saudi Arabia

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Abstract

Introduction: Oral contraceptive pills (OCPs) are the most popular contraception method in Saudi Arabia due to their accessibility and reversibility. However, there is no recommendation to stop OCP medication before or after elective aesthetic surgery. The study involves identifying plastic surgeons' behaviors and current practices in perioperative OCPs management in aesthetic surgery in Saudi Arabia, which is the first of its kind.

Methods: A validated self-administered survey was distributed in February 2022 among all board-certified plastic surgeons in Saudi Arabia via social media. The questionnaire was developed to gather information on the perioperative management of OCPs in aesthetic surgery.

Results: A total of 46 board-certified plastic surgeons participated (overall response rate of 48.4%). Among the participants, 32 surgeons (69.6%) indicated that they instruct their patients to discontinue OCPs preoperatively. More than half of surgeons have instructed their patients to stop OCPs after plastic surgery (52.2%). Based on the three occupational characteristics of the surgeons, we found no significant associations between surgeons’ practice patterns regarding OCP discontinuation preoperatively or postoperatively.

Conclusion: In light of the fact that OCPs are reported to pose a risk for venous thromboembolic events, our survey found that most aesthetic surgeons cease their use both preoperatively and postoperatively. There is a need for a guideline regarding perioperative measures for OCPs.

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Most cited references 24

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Combined oral contraceptives: venous thrombosis

Marcos de Bastos, Bernardine H. Stegeman, Frits R. Rosendaal … (2014)

Combined oral contraceptive (COC) use has been associated with venous thrombosis (VT) (i.e., deep venous thrombosis and pulmonary embolism). The VT risk has been evaluated for many estrogen doses and progestagen types contained in COC but no comprehensive comparison involving commonly used COC is available.

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Estrogen and thrombosis: A bench to bedside review.

Mouhamed Abou-Ismail, Divyaswathi Citla Sridhar, Lalitha Nayak (2020)

Estrogen, in the clinical setting is used primarily for contraception and hormone replacement therapy. It has been well established that estrogen increases the risk of both arterial and venous thrombosis. While estrogen is known to induce a prothrombotic milieu through various effects on the hemostatic pathways, the exact molecular mechanism leading to those effects is not known. The most common clinical presentation of estrogen-related thrombosis is venous thromboembolism (VTE) of the deep veins of the legs or pulmonary vessels, usually within the first few months of use. Estrogen has also been associated with increased risk of "unusual site" thromboses, as well as arterial thrombosis. Women at high-risk of thrombosis need careful evaluation and counseling for contraception, pregnancy, menopausal hormonal therapy and other estrogen-related conditions or treatments in order to lower the risk of thromboses. We review the most recent evidence on management of high-estrogen states in women at high-risk of thrombosis, as well as emerging data on unique populations such as transgender women. More studies are needed to better understand the pathophysiology of hormone-related thrombosis, as well as more comprehensive techniques to stratify risks for thrombosis so as to enable tailoring of recommendations for each individual.

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Combined Oral Contraceptives and Venous Thromboembolism: Review and Perspective to Mitigate the Risk

Laure Morimont, Hélène Haguet, Jean-Michel Dogné … (2021)

Many factors must be considered and discussed with women when initiating a contraceptive method and the risk of venous thromboembolism (VTE) is one of them. In this review, we discuss the numerous strategies that have been implemented to reduce the thrombotic risk associated with combined oral contraceptives (COCs) from their arrival on the market until today. Evidences suggesting that COCs were associated with an increased risk of VTE appeared rapidly after their marketing. Identified as the main contributor of this risk, the dosage of the estrogen, i.e., ethinylestradiol (EE), was significantly reduced. New progestins were also synthetized (e.g., desogestrel or gestodene) but their weak androgenic activity did not permit to counterbalance the effect of EE as did the initial progestins such as levonorgestrel. Numerous studies assessed the impact of estroprogestative combinations on hemostasis and demonstrated that women under COC suffered from resistance towards activated protein C (APC). Subsequently, the European Medicines Agency updated its guidelines on clinical investigation of steroid contraceptives in which they recommended to assess this biological marker. In 2009, estradiol-containing COCs were marketed and the use of this natural form of estrogen was found to exert a weaker effect on the synthesis of hepatic proteins compared to EE. In this year 2021, a novel COC based on a native estrogen, i.e., estetrol, will be introduced on the market. Associated with drospirenone, this preparation demonstrated minor effects on coagulation proteins as compared with other drospirenone-containing COCs. At the present time, the standard of care when starting a contraception, consists of identifying the presence of hereditary thrombophilia solely on the basis of familial history of VTE. This strategy has however been reported as poorly predictive of hereditary thrombophilia. One rationale and affordable perspective which has already been considered in the past could be the implementation of a baseline screening of the prothrombotic state to provide health care professionals with objective data to support the prescription of the more appropriate contraceptive method. While this strategy was judged too expensive due to limited laboratory solutions, the endogenous thrombin potential-based APC resistance assay could now represent an interesting alternative.

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 5 November 2022

Publication date (Electronic, collection): November 2022

Volume: 14

Issue: 11

Electronic Location Identifier: e31121

Affiliations

[1 ] Plastic and Reconstructive Surgery, King Abdullah Medical City, Makkah, SAU

[2 ] Plastic Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU

[3 ] Plastic and Reconstructive Surgery, King Abdulaziz Medical City, Jeddah, SAU

[4 ] Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, SAU

[5 ] Plastic Surgery, King Saud University Medical City, Riyadh, SAU

[6 ] Plastic and Reconstructive Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, SAU

Author notes

Noor H. Allababidi noory.lababidi@ 123456gmail.com

Article

DOI: 10.7759/cureus.31121

PMC ID: 9720713

PubMed ID: 36479411

SO-VID: 0ccd4034-39fd-446b-923d-046d278be8cf

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date accepted : 5 November 2022

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