COC and surgery

Day surgery has not significantly altered the risk of complications in those taking an oestrogen-containing oral contraceptive.

Elective major surgery without prophylaxis in this group is associated with a doubling of the risk of deep vein thrombosis, and hence an increased risk of pulmonary embolism relative to the general population. Two possible strategies are available and neither is, at present, definitive

• NICE state that:
  • advise patients to consider stopping oestrogen-containing oral contraceptives or hormone replacement therapy 4 weeks before elective surgery. If stopped, provide advice on alternative contraceptive methods

In emergency major surgery in this group, the following measures are recommended:

• subcutaneous heparin
• elasticated, graduated compression stockings
• early mobilization

Regional anaesthesia might be a viable alternative.

These recommendations do not apply to minor surgery with short duration of anaesthesia e.g. tooth extraction, or to women taking oestrogen-free hormonal contraceptives.

Reference:

• NICE (January 2010). Reducing the risk of venous thromboembolism