<p>Sir,</p> <p>We read the article "oral contraceptive misuse as a risk factor for cerebral venous and sinus thrombosis" by "Saadat-niya et al," which has been published in the recent issue of your journal. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>It was a very interesting article. As it was emphasized in the article, taking oral contraceptives has been increasing to a great extent in Iran in recent years and more than 2/3 of women at fertility age do so. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>Although the main goal of taking such pills is to postpone conception and control population growth, these pills are also being used to postpone menstruation during the blessed Ramadan month and Mecca (Haj) pilgrimage. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>After the Advantageous Mecca pilgrimage (Haj-e-tamatto) of last year (2011), a 38-year-old woman with deep vein thrombosis of the left leg was hospitalized in the cardiology ward of Valli-e-asr hospital in Birjand. Misuse of oral contraceptives (two times the normal dose) for two months and long-time flight journies were considered to be the underlying causes. On the second day, because of not taking complete bedrest, acute pulmonary emboli (PE) was occured. PE was diagnosed timely and confirmed through transthorasic echocardiography and CT angiography. The patient was administered thrombolytic drugs and now, while she is feeling well, is using warfarin.</p> <p>Misuse and taking without a physician′s prescription of oral contraceptives, usually with over-normal dose, occured and this intensified the side-effects of these drugs. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>One of the most important side effects of such pills concerns the cardiovascular system. The incidence of venous thromboembolism (VTE) in healthy women is 4-5/10000 per year, but the risk reaches 9-10/10000 women per year among those taking oral contraceptives; and if other risk factors like sedentary lifestyle are added the chance of thromboembolism further increases. <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>Various studies have been conducted to explore the relationship between long flight journey and thromboembolism, in the majority of which such a relationship has been observed. This risk further increases if other predisposing factors such as sitting position of the passenger, inactivity, relative hypoxia, dehydration following taking diuretics like tea, and hot weather. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>Therefore, these factors should be considered in any long lasting trip. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup></p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Saadatnia</surname> <given-names>M</given-names> </name> <name> <surname>Naghavi</surname> <given-names>N</given-names> </name> <name> <surname>Fatehi</surname> <given-names>F</given-names> </name> <name> <surname>Zare</surname> <given-names>M</given-names> </name> </person-group> <article-title>Oral contraceptive misuse as a risk factor for cerebral venous and sinus thrombosis</article-title> <source>J Res Med Sci</source> <year>2012</year> <volume>17</volume> <fpage>344</fpage> <lpage>7</lpage> </nlm-citation> </ref> <ref id="ref2"> <label>2</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Fathizadeh</surname> <given-names>N</given-names> </name> <name> <surname>Salemi</surname> <given-names>P</given-names> </name> <name> <surname>Ehsanpour</surname> <given-names>S</given-names> </name> </person-group> <article-title>Dissatisfaction with contraceptive methods</article-title> <source>Iran J Nurs Midwifery Res</source> <year>2011</year> <volume>16</volume> <fpage>79</fpage> <lpage>82</lpage> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Ehsanpour</surname> <given-names>S</given-names> </name> <name> <surname>Aghaii</surname> <given-names>A</given-names> </name> <name> <surname>KheirabadiGR</surname> <given-names></given-names> </name> </person-group> <article-title>The association of contraceptive methods and depression</article-title> <source>Iran J Nurs Midwifery Res</source> <year>2012</year> <volume>17</volume> <fpage>1</fpage> <lpage>5</lpage> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Wiegratz</surname> <given-names>I</given-names> </name> <name> <surname>Thaler</surname> <given-names>CJ</given-names> </name> </person-group> <article-title>Hormonal contraception--what kind, when, and for whom?</article-title> <source>DtschArzteblInt</source> <year>2011</year> <volume>108</volume> <fpage>495</fpage> <lpage>505</lpage> </nlm-citation> </ref> <ref id="ref5"> <label>5</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Adi</surname> <given-names>Y</given-names> </name> <name> <surname>Bayliss</surname> <given-names>S</given-names> </name> <name> <surname>Rouse</surname> <given-names>A</given-names> </name> <name> <surname>Taylor</surname> <given-names>RS</given-names> </name> </person-group> <article-title>The association between air travel and deep vein thrombosis: Systematic review and meta-analysis</article-title> <source>BMC CardiovascDisord</source> <year>2004</year> <volume>4</volume> <fpage>7</fpage> </nlm-citation> </ref> <ref id="ref6"> <label>6</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"></person-group> <article-title></article-title> <source></source> <year></year> <volume></volume> <fpage></fpage> </nlm-citation> </ref> </ref-list> </back> </article>

JRMS

J Res Med Sci

Journal of Research in Medical Sciences

1735-1995 1735-7136

Medknow Publications Pvt Ltd

India

JRMS-17-894

23826022

Letter to Editor

Pulmonary emboli following oral contraceptive misuse and long air travel

Kazemi

Toba

Javadinia

Seyed A

Birjand Atherosclerosis and Coronary Artery Research Center, Birjand, Iran Student Research comitte, Birjand University of Medical Science, Birjand, Iran

Address for correspondence:Toba Kazemi, Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Science, Ghafari Street, Birjand, Iran drtooba.kazemi@gmail.com

September 2012

17 9 894 894

2012

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

<p>Sir,</p> <p>We read the article "oral contraceptive misuse as a risk factor for cerebral venous and sinus thrombosis" by "Saadat-niya et al," which has been published in the recent issue of your journal. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>It was a very interesting article. As it was emphasized in the article, taking oral contraceptives has been increasing to a great extent in Iran in recent years and more than 2/3 of women at fertility age do so. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup>Although the main goal of taking such pills is to postpone conception and control population growth, these pills are also being used to postpone menstruation during the blessed Ramadan month and Mecca (Haj) pilgrimage. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>After the Advantageous Mecca pilgrimage (Haj-e-tamatto) of last year (2011), a 38-year-old woman with deep vein thrombosis of the left leg was hospitalized in the cardiology ward of Valli-e-asr hospital in Birjand. Misuse of oral contraceptives (two times the normal dose) for two months and long-time flight journies were considered to be the underlying causes. On the second day, because of not taking complete bedrest, acute pulmonary emboli (PE) was occured. PE was diagnosed timely and confirmed through transthorasic echocardiography and CT angiography. The patient was administered thrombolytic drugs and now, while she is feeling well, is using warfarin.</p> <p>Misuse and taking without a physician′s prescription of oral contraceptives, usually with over-normal dose, occured and this intensified the side-effects of these drugs. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>One of the most important side effects of such pills concerns the cardiovascular system. The incidence of venous thromboembolism (VTE) in healthy women is 4-5/10000 per year, but the risk reaches 9-10/10000 women per year among those taking oral contraceptives; and if other risk factors like sedentary lifestyle are added the chance of thromboembolism further increases. <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup>Various studies have been conducted to explore the relationship between long flight journey and thromboembolism, in the majority of which such a relationship has been observed. This risk further increases if other predisposing factors such as sitting position of the passenger, inactivity, relative hypoxia, dehydration following taking diuretics like tea, and hot weather. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>Therefore, these factors should be considered in any long lasting trip. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup></p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Saadatnia</surname> <given-names>M</given-names> </name> <name> <surname>Naghavi</surname> <given-names>N</given-names> </name> <name> <surname>Fatehi</surname> <given-names>F</given-names> </name> <name> <surname>Zare</surname> <given-names>M</given-names> </name> </person-group> <article-title>Oral contraceptive misuse as a risk factor for cerebral venous and sinus thrombosis</article-title> <source>J Res Med Sci</source> <year>2012</year> <volume>17</volume> <fpage>344</fpage> <lpage>7</lpage> </nlm-citation> </ref> <ref id="ref2"> <label>2</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Fathizadeh</surname> <given-names>N</given-names> </name> <name> <surname>Salemi</surname> <given-names>P</given-names> </name> <name> <surname>Ehsanpour</surname> <given-names>S</given-names> </name> </person-group> <article-title>Dissatisfaction with contraceptive methods</article-title> <source>Iran J Nurs Midwifery Res</source> <year>2011</year> <volume>16</volume> <fpage>79</fpage> <lpage>82</lpage> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Ehsanpour</surname> <given-names>S</given-names> </name> <name> <surname>Aghaii</surname> <given-names>A</given-names> </name> <name> <surname>KheirabadiGR</surname> <given-names></given-names> </name> </person-group> <article-title>The association of contraceptive methods and depression</article-title> <source>Iran J Nurs Midwifery Res</source> <year>2012</year> <volume>17</volume> <fpage>1</fpage> <lpage>5</lpage> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Wiegratz</surname> <given-names>I</given-names> </name> <name> <surname>Thaler</surname> <given-names>CJ</given-names> </name> </person-group> <article-title>Hormonal contraception--what kind, when, and for whom?</article-title> <source>DtschArzteblInt</source> <year>2011</year> <volume>108</volume> <fpage>495</fpage> <lpage>505</lpage> </nlm-citation> </ref> <ref id="ref5"> <label>5</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Adi</surname> <given-names>Y</given-names> </name> <name> <surname>Bayliss</surname> <given-names>S</given-names> </name> <name> <surname>Rouse</surname> <given-names>A</given-names> </name> <name> <surname>Taylor</surname> <given-names>RS</given-names> </name> </person-group> <article-title>The association between air travel and deep vein thrombosis: Systematic review and meta-analysis</article-title> <source>BMC CardiovascDisord</source> <year>2004</year> <volume>4</volume> <fpage>7</fpage> </nlm-citation> </ref> <ref id="ref6"> <label>6</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"></person-group> <article-title></article-title> <source></source> <year></year> <volume></volume> <fpage></fpage> </nlm-citation> </ref> </ref-list> </back> </article>