Original research article Oral contraceptives and venous thromboembolism: a five-year national case-control study (original) (raw)
Related papers
Oral contraceptives and thrombotic diseases: impact of new epidemiological studies [editorial]
Contraception, 1996
Four epidemiological studies have examined the effect of various types of oral contraceptives (OCs) on the risk of developing deep venous thrombosis and pulmonary embolism collectively referred to as venous thromboembolism (VTE). They suggest that women using OCs containing the third generation progestins desogestrel or gestodene face a greater risk of non-fatal VTE than women using OCs with less than 50 mcg ethinyl estradiol and a second generation progestin (generally levonorgestrel). The countries involved in the studies were the Netherlands England Europe and in one study 17 countries worldwide. The odds ratio (OR) of developing VTE among users of OCs with the third generation progestins ranged from 4.8 to 8.7 when compared with nonusers. It ranged from 3.2 to 3.8 for users of second generation OCs. In the study comparing the third generation OCs with the second generation OCs the OR for third generation OCs was 2.2. All the studies controlled for age and previous thrombosis. No...
Epidemiology of the contraceptive pill and venous thromboembolism
Thrombosis Research, 2011
Current users of combined oral contraceptives have an increased risk of venous thromboembolism. The risk appears to be higher during the first year of use and disappears rapidly once oral contraception is stopped. There is a strong interaction between hereditary defects of coagulation, combined oral contraceptive use and venous thromboembolism. Nevertheless, the routine screening of women before they use combined oral contraception is not recommended. Venous thromboembolism seems to be higher in overweight users, and after air, and possibly other forms of, travel. Both the oestrogen and progestogen content of combined oral contraceptives have been implicated in differences in venous thrombotic risk between products. Even if real, the absolute difference in risk between products is small, because the background incidence of venous thromboembolism in young women is low. All currently available combined oral contraceptives are safe. Progestogen-only oral contraceptives are not associated with an increased risk of venous thromboembolism.
2010
Correspondence to: Professor Robert L Reid, Department of Obstetrics and Gynecology, Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada ON K7L 4V7. E-mail: robert.reid@queensu.ca Background and purpose of the workshop Concern about the venous thromboembolism (VTE) risk of new hormonal contraceptive options shortly after their entry into the market has triggered a number of ‘pill scares’, each of which resulted in panic stopping of the formulations in question and a spike in unplanned pregnancies, yet with no subsequent reduction in VTE rates among women of reproductive age. Perhaps the best example of a recent pill scare that resulted in enormous harm from a public health perspective was the ‘third-generation pill scare’ that occurred in many countries in Europe and around the world in 1995. At that time the new third-generation pills were promoted as being less androgenic and as possibly having fewer adverse effects on cardiovascular and metabolic parameters ...
Journal of Epidemiology & Community Health, 1997
Study objective-To investigate whether there has been an increase of venous thromboembolism (VTE) mortality in European countries, concurrent with the replacement of second generation by third generation combined oral contraceptives (COCs). Such an increase has been predicted, and reportedly detected, because published studies have detected an increased incidence of VTE associated with third generation rather than second generation COC use. Design-Data were collected on population and annual VTE mortality in women 15-34 and 35-49 years old, and on second and third generation COC sales, from 1981 to 1994 in 13 European countries. Data from the seven most populous countries were analysed by linear regression of annual VTE mortality, in the 15-34 and 15-49 age groups, with respect to calculated total and third generation COC use rates, and the regression coefficients used to estimate mortality differences between second generation users and non-users and between third and second generation users, respectively. Main results-The estimated mortality
Thrombotic diseases in young women and the influence of oral contraceptives*1
American Journal of Obstetrics and Gynecology, 1998
In the evaluation of the clinical impact of thrombotic diseases in young women, age-specific incidence rates must be calculated for both arterial and venous thrombotic diseases, but also the case-fatality rate and figures for the clinical consequences among those who survive thrombosis must be included. The aim of this analysis was to quantify the clinical impacts of both arterial and venous thrombotic diseases among young, nonpregnant women and thereafter to assess the influences of oral contraceptives on these measures. STUDY DESIGN: Nationwide register data on the morbidity and mortality of venous thromboembolism, myocardial infarction, and thrombotic stroke in Denmark, 1980-1993, and 3 ongoing case-control studies to assess the influence of oral contraceptives on the risk for development of these thrombotic diseases. RESULTS: In women 15-29 years old venous thromboembolism is about twice as common as arterial complications, whereas in women 30-44 years old the number of arterial complications exceeds that of venous diseases by about 50%. The mortality rate from arterial diseases is 3.5 times higher than that from venous diseases among women <30 years old and 8.5 times higher than that from venous diseases in women 30-44 years old. The proportion of women with a significant disability among women who had an arterial complication was about 30%; the proportion was about 5% among women with venous thromboembolism. CONCLUSION: Anticipating a differential influence on venous and arterial diseases from oral contraceptives with second-and third-generation progestogens, it was calculated that users of oral contraceptives with second-generation progestogens had 30% greater increased risk of thrombotic diseases, 260% greater increased risk of thrombotic deaths, and 220% greater increased risk of thrombotic disability than users of oral contraceptives with third-generation progestogens.