Aortic thrombus with contraceptive vaginal ring use

Abstract

Background

Combination hormonal contraceptives are widely used and are available in various dosage forms. Thromboembolism is an established risk factor associated with the use of these agents, with increased rates of arterial thrombosis and venous thromboembolism reported. Arterial thromboembolism occurs much less frequently and is associated with more serious short-term and long-term consequences.

Aim

We report a case of aortic thrombus occurring secondary to NuvaRing use with concomitant smoking. There are no other reports of aortic thrombus resulting from contraceptive vaginal ring (CVR) use reported in the literature.

Clinical Details

This case describes a 35-year-old female patient with disabling claudication, severe aortoiliac stenosis, and end organ damage resulting from a nearly occlusive aortic thrombus with no identifiable source of emboli. The patient's past medical history was significant for tachycardia and tobacco use disorder. Her scheduled medicines most notably included NuvaRing for contraception. Oral anticoagulation was initiated, and the patient agreed to pursue tobacco cessation. Haematology consultation and workup was negative. Months later, an open infrarenal abdominal aorta thromboendarterectomy and bovine patch angioplasty were completed. The clinical pharmacist conducting intensive care unit admission medication reconciliation postoperatively identified continued NuvaRing use, in addition to smoking. NuvaRing was promptly discontinued. Repeat hypercoagulable workup has remained negative.

Outcome

Following NuvaRing and smoking cessation, no thrombotic symptoms have recurred.

Conclusion

NuvaRing should be considered as potential aetiology for venous and arterial thromboembolism.