Resistance to APC and SHBG levels during use of a four-phasic oral contraceptive containing dienogest and estradiol valerate: a randomized controlled trial

M. Raps*, F. Rosendaal, B. Ballieux, J. Rosing, S. Thomassen, F. Helmerhorst, H. Van Vliet

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Web of Science)


Background The use of combined oral contraceptives is associated with a 3- to 6-fold increased risk of venous thrombosis. This increased risk depends on the estrogen dose as well as the progestogen type of combined oral contraceptives. Thrombin generation-based activated protein C resistance (APC resistance) and sex hormone-binding globulin (SHBG) levels predict the thrombotic risk of a combined hormonal contraceptive. Recently, a four-phasic oral contraceptive containing dienogest (DNG) and estradiol valerate (E2V) has been marketed. The aim of this study was to evaluate the thrombotic risk of the DNG/E2V oral contraceptive by comparing APC resistance by measuring normalized APC sensitivity ratios (nAPCsr) and SHBG levels in users of oral contraceptives containing dienogest and estradiol valerate (DNG/E2V) and oral contraceptives containing levonorgestrel and ethinyl estradiol (LNG/EE). Methods We conducted a single-center, randomized, open label, parallel-group study in 74 women using DNG/E2V or LNG/EE, and measured nAPCsr and SHBG levels in every phase of the regimen of DNG/E2V. Results During the pill cycle SHBG levels did not differ between DNG/E2V users and LNG/EE users. nAPCsr levels were overall slightly lower in DNG/E2V users than in LNG/EE users, mean difference 0.44 (95% CI, 1.04 to 0.17) for day 2, 0.20 (95% CI, 0.76 to 0.37) for day 7, 0.27 (95% CI, 0.81 to 0.28) for day 24 and 0.34 (95% CI, 0.91 to 0.24) for day 26. Conclusion No statistical significant differences in nAPCsr and SHBG levels were found between users of the oral contraceptive containing DNG/E2V and LNG/EE, suggesting a comparable thrombotic risk
Original languageEnglish
Pages (from-to)855-861
JournalJournal of Thrombosis and Haemostasis
Issue number5
Publication statusPublished - May 2013


  • activated protein C resistance
  • natural estrogen
  • oral contraceptives
  • sex hormone binding globulin
  • thrombotic risk

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