Ask Dr. Stephan Moll

These questions have been submitted by folks on the mailing list and answered by Dr. Moll, Director of the Thrombophilia Program at the Carolina Cardiovascular Biology Center, Department of Medicine, Division of Hematology-Oncology, UNC Chapel Hill (North Carolina, USA). Why am I doing this?

14. Oral contraceptives and coumadin

Q: I recently had a thrombosis and I am now on coumadin®. I just received news from a Thrombosis specialist, that it wouldn't be a problem for me to go back on the birth control pill since I am taking coumadin. I find this very puzzling, considering that the only cause for my having thrombosis, they have been able to identify, is having been on the pill. Do you recommend someone taking the pill while on coumadin? I am 39 years old…."

A: No, I don't recommend it. But I also do not strongly advise against it in most women.

I rather not see a woman who has had a thrombosis associated with oral contraceptives or hormone replacement therapy, who is now on coumadin take the pill or hormones. However, one can make an argument that that it is probably o.k., since the patient is now protected by coumadin.

However, if the woman has fluctuating INRs and has low INRs at times (i.e. is below her therapeutic range), the pill or hormones may pose a risk for recurrence of clots. Also, in women with antiphospholipid antibody syndrome, who may be at particularly increased risk for re-clotting, even with therapeutic INRs, I strongly recommend against resuming the pill and hormones.

<< Back To Ask The Doctor...