On 18/8, representatives from Nhan Dan 115 Hospital reported that a patient arrived in the emergency room with severe shortness of breath, chest tightness, dizziness, and low blood pressure. An electrocardiogram (ECG) and echocardiogram indicated acute right heart overload, a common sign of severe acute pulmonary embolism.
The patient was transferred to the Intensive Care and Toxicology Unit, with ECMO (extracorporeal membrane oxygenation) on standby. Doctors diagnosed high-risk obstructive shock due to pulmonary embolism, accompanied by bilateral popliteal vein thrombosis. They identified long-term use of combined oral contraceptives as a risk factor. Her occupation, which involves prolonged sitting at a sewing machine, also increased the risk of venous thrombosis, leading to pulmonary embolism.
The patient received thrombolytic medication to dissolve the blood clots causing the pulmonary embolism. Within an hour of administration, she showed significant improvement: increased alertness, reduced shortness of breath and chest tightness, improved blood pressure, and a significant reduction in the required dosage of vasopressor medication. Her right heart function also improved.
After a week of treatment, the woman has almost fully recovered and will continue to be monitored for optimal management of her thrombotic condition before discharge. A gynecologist will advise her on alternative contraceptive methods with lower thrombotic risks.
Pulmonary embolism due to thrombosis is a common medical emergency, often missed if not diagnosed promptly. Severe cases carry a high risk of death. Combined oral contraceptives (containing estrogen and progestin), particularly the estrogen component, can increase the risk of deep vein thrombosis and pulmonary embolism, especially in women who use them long-term, smoke, are obese, or have underlying cardiovascular conditions.
Besides combined oral contraceptives, women have access to various other contraceptive methods with higher safety profiles, depending on their health status and with guidance from a gynecologist. For instance, progestin-only pills, contraceptive implants, or hormonal intrauterine devices (IUDs) carry a significantly lower risk of thrombosis because they don't contain estrogen.
Copper IUDs also do not affect the blood clotting system, making them suitable for women at risk of thrombosis or those for whom hormonal contraceptives are contraindicated. Condoms offer effective contraception while also protecting against sexually transmitted infections. Progestin injections and male or female sterilization are also options, depending on individual needs and circumstances.
Women should not use oral contraceptives long-term without a doctor's prescription and monitoring. Factors such as age, history of cardiovascular or thrombotic disease, smoking, obesity, diabetes, or liver disease should be carefully considered before long-term use of hormonal contraceptives.
Le Phuong
