Sex hormone-binding globulin: an adequate surrogate marker for venous thromboembolism in women using new hormonal contraceptives.

摘要

In a recent commentary in Contraception [1], Stanczyk and Grimes critically evaluate the literature on sex hormone-binding globulin (SHBG) as a marker for the thrombotic risk of oral contraceptives. After an educative resume on surrogate markers and the physiology of SHBG, the authors question the hypothesis that the effect of a hormonal contraceptive on SHBG plasma levels is a marker for the thrombotic risk of the hormonal contraceptive. This hypothesis was postulated after the observation that users of oral contraceptives with a high thrombotic risk had higher SHBG plasma levels than users of low-risk oral contraceptives and the observation that SHBG plasma levels were positively associated with resistance to the anticoagulant action of activated protein C (APC) [2-4]. As main arguments, Stanczyk and Grimes [1] state that "all contemporary combined oral contraceptives in Europe are associated with a similar risk of venous thromboembolism" and that "APC resistance has not been shown to be a valid marker for venous thromboembolism."