Science- A new report warns that certain types of
birth control pills, pregnancy, and hormone therapies may increase the risk of "deadlyblood clots " incoronavirus patients. - Both estrogen and COVID-19 are linked to an increase risk in the clots.
- More research is needed before making any one-size-fits all recommendations, and patients should talk to their providers to weight their risks.
Coronavirus patients who are pregnant, on certain birth control pills, or taking estrogen-based hormone replacement therapy may be especially vulnerable to potentially deadly blood clots, doctors warn in a (not-yet-peer-reviewed) manuscript out today in Endocrinology.
That's because estrogen — which goes up during pregnancy and is a key ingredient in many types of birth control and HRT — is known to increase the risk of blood clots. COVID-19 seems to do the same.
The two together, then, may amplify the risk, the doctors hypothesize.
But more research is needed to learn more about how the two factors interplay, and how patients respond to the potentially increased risk needs to be balanced with the downsides of stopping medication or receiving an anti-clotting medication while pregnant.
"This definitely needs to be [decided through] individualized counseling where patients are really presented with all of their options," Dr. Rachel Becker Rapkin, an OB-GYN at the University of South Florida, told Insider.
Blood clot risk is still pretty low among women on birth control pills
Combined oral contraceptives, or those with both estrogen and progestin, increase the risk of blood clots (technically called venous thromboembolism or VTE) two to six times when compared to women not on the pill.
They also increase the risk of clots when compared to progestin-only birth control pills, though the risk is still "very low," according to the American College of Obstetricians and Gynecologists, at only a 0.3% to 1% over 10 years on the pill.
The patch and the ring, but not IUDs, also may raise your risk of clots because they have estrogen while IUDs do not.
The risk of clotting is much higher during pregnancy and right after childbirth than on estrogen-based birth control.
In terms of the risks COVID-19 poses for blood-clot development, one July study found 31% of ICU patients had "thrombotic complications," which the researchers called "remarkably high."
Autopsy studies of coronavirus patients have shown the clots appear in "almost every organ," a result study author Dr. Amy Rapkiewicz, NYU Langone Medical Center's chair of the department of pathology, told CNN was "dramatic."
Even people with mild cases of COVID-19 who don't wind up in the hospital may experience blood clots, but it's unclear how often that's the case.
Clots can block veins and lead to strokes, heart attacks, kidney problems, lung problems, and more.
How to respond to the potential increased clot risk varies by patient
The paper's corresponding author, Dr. Daniel I. Spratt of Tufts University School of Medicine, said in a press release that more research is needed to know whether, on the whole, women on estrogen-based birth control pills or HRT should stop if they get COVID-19.
It's also unclear whether pregnant women with COVID-19 should receive a type of anti-clotting therapy, he said.
"Research that helps us understand how the coronavirus causes blood clots may also provide us with new knowledge regarding how blood clots form in other settings and how to prevent them," Spratt added.
Meantime, Rapkin said it's important for women and their doctors to make a decision that's right for them while considering the trade-offs.
"If women stop their birth control but keep having sex," she said, "they're then at risk for unplanned pregnancies, and we know the risk of clot is higher with pregnancy than with estrogen-containing contraceptives."
The same goes for people on estrogen-containing HRT, with age and comorbidities like heart disease, obesity, and a family history of blood clots being important considerations, ACOG says.
Doctors should continue to make recommendations, the organization says, "based on the individual patient's desires, risks factors, and needs."
- Read more:
- An NYU pathologist says blood clots were found in 'almost every organ' of coronavirus patients' autopsies
- Blood clots are a common and deadly complication of the coronavirus, and doctors are stepping up their efforts to prevent them
- Blood clots are the latest life-threatening complication of the coronavirus, but doctors aren't sure how to treat them
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