Diagnostic screening for risk of cerebral venous thrombosis in young patients taking oral contraceptives

Abstract

Cerebral venous thrombosis is rarely diagnosed in young patients, approximately 3–4 cases per a million people in the general population. This is probably due to the fact that the clinical manifestations of CVT are nonspecific and vary from isolated headaches to individual neurological symptoms. On the other hand, the detection of this pathology is difficult due to the lack of awareness of physicians about the diagnostic screening of risk factors. In recent years, risk factors associated with disorders in the blood coagulation system (genetically determined and acquired coagulopathy) and changes in the vascular wall have come to the fore, especially in female patients using oral contraceptives. However, the prescription of this group of drugs does not take into account the risk of developing vascular complications, such as cerebral vein thrombosis, so the concept of primary vigilance in adolescents with menstrual irregularities and women of reproductive age when prescribing hormonal drugs should be based on careful screening for changes in the coagulation system. organism. The concept of primary vigilance in the appointment of hormonal drugs should be based on careful screening for congenital or acquired changes in the coagulation system of the body. Significant genetic mutations for diagnosis are Leiden and F2-prothrombin G20210A, methylenetetrohydrophosphate reductase (MTHFR), plasminogen activator inhibitor (PAI-I), factor VII, glycoprotein (GP IIIa), deficiency of proteins C, S, and antithrombin. It is advisable to include the determination of vitamins B in screening. In non-pregnant women, folate deficiency can only be detected in erythrocytes, while normal in plasma. If any mutation is found in a patient, it is necessary to examine his next of kin to clarify their genetic profile and timely use of preventive measures against thrombosis, it is recommended to replace oral contraceptives with other methods of contraception. If a history of thrombosis has previously occurred, lifelong treatment with anticoagulants is indicated.