الفهرس 
Mechanisms of Haemostasis and ThrombosisOnly 14 pages are availabe for public view
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Abstract
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SUMMARY AND CONCLUSIONS
In the present study, various haemostatic and serum lipid parameters were prospectively investigated in 30 women receiving DMPA injections in a dose of 150 mg intramuscularly every 3 months, for birth control. All women were clinically healthy, not obese, not hypertensive, not diabetic, with no history of liver disease or thromboembolism and did not use any hormonal contraception for at least 6 months before admission in the study.
To study the risk of venous thrombosis in this group, platelets, coagulation and fibrinolysis were assessed using various parameters that included; estimation of bleeding time, platelet count, circu-lating platelet aggregates, platelet factor 4, proth-rombin time, activated partial thromboplastin time, thrombin time, fibrinogen, factor VIII, factor IX, antithrombin. III, tests for detection of soluble fibrin monomer complexes and estimation of fibrinogen/ fibrin degradation px:oducts (FDPs).
To study the risk of atherosclerosis, serum lipid parameters were assessed including; total lipids, total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol and lipoprotein electrophoresis.
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The results obtained after 3 and 15 months of DMPA use were compared with the pretreatment values and the following changes were reported:
1-There was a significant increase in the mean body weight after 3 months (P< 0.01) and 15 months (P< 0.001) of DMPA use.
2-No statistically significant change was detected in the mean systolic and diastolic blood pressure after 3 and 15 months of DMPA use.
3-No statistically significant change was found in the various platelet and coagulation para-meters after 3 and 15 months of DMPA use.
4-A significant reduction in the mean plasma antithrombin III was detected after 15 months of use of DMPA (PC 0.01).
5-No activation of in vivo-fibrinolysis was detec-ted with DMPA use.
6-Total lipids and total cholesterol were not significantly changed after 3 months of DMPA use. While, both were significantly increased after 15 months of DMPA use (P< 0.001).
7-No significant change was found in the mean serum triglycerides after 3 and 15 months of DMPA use.
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8-There was a significant reduction in mean HDL-cholesterol after 3 and 15 months of DMPA use (P< 0.001).
9-There was a significant increase in mean LDL-cholesterol after 3 months (P< 0.01) and 15 months (P< 0.001) of DMPA use.
10-Lipoprotein electrophoresis showed a significant increase in Tl-lipoprotein % and the pattern of hyperlipoproteinemia detected was type IIa.
11-There was a significant increase in total choles-terol/HDL-cholesterol and LDL-cholesterol/HDL-cholesterol ratios after 3 and 15 months of DMPA use (P< 0.001). While HDL-Cholesterol/total cholesterol-HDL-cholesterol ratio showed a
significant decrease (P< 0.001). All these changes suggest a significant increase in the risk of atherosclerosis.
12-No significant correlation was found between the changes in platelets and the changes in serum lipids.
13-No significant correlation was found between the reduction in antithrombin III and the age or the changes in body weight, blood pressure and serum lipids.
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14- The changes in HDL-cholesterol were inversely correlated with the changes in body weight after 3 months of DMPA use (P< 0.05). The changes
were not correlated with the age of the study group.
Regarding the changes in haemostatic and serum
lipid parameters with DMPA use, we conclude that:
1-There is no risk of venous thrombosis after
3 months of DMPA use as shown by the absence of any significant change in various haemostatic
parameters.
2-After 15 months of DMPA use, there is a slight risk of venous thrombosis, due to significant
reduction in antithrombin III.
3-The risk of atherosclerosis was evident after 3 months of DMPA use and it increased with the duration of use. This risk was not signifi-cantly correlated with the age of the study
gorup.
The findings of this study need to be confirmed by further studies involving larger number of DMPA, long-term users to evaluate the real size of the risk of atherosclerosis with DMPA use.