The Risk of Venous Thromboembolism with Different Generation of Oral Contraceptives; a Systematic Review and Meta-Analysis
Archives of Academic Emergency Medicine,
Vol. 2 No. 1 (2014),
1 February 2014
,
Page 1-11
https://doi.org/10.22037/aaem.v2i1.14
Abstract
Introduction: Oral contraceptives (OCs) are considered as one of the most common risk factor of venous thromboembolism (VTE) in childbearing age. Some of the recent researches indicate that the odds of VTE may be even higher with newer generations of OCs. The present meta-analysis was designed to evaluate the effect of different generation of OCs on the occurrence of VTE. Methods: Two researchers independently ran a thorough search in Pubmed, ISI Web of Science, EMBASE, CINAHL and Scopus databases regarding study keywords including thromboembolic event, thromboembolism, embolism, thromboembolic, thrombotic and thrombosis, combined with oral contraceptive. The outcomes were the incidence of diagnosed thromboembolism, such as deep vein thrombosis, pulmonary embolism and cerebral venous thrombosis. Based on the heterogeneity of the studies, random effect model was used and pooled odds ratio was reported. Results: Three cohort and 17 case-control studies with 13,265,228 subjects were entered into meta-analysis. Analysis showed that the odds of VTE in women taking OCs are more than three-fold (OR=3.13; 95% CI: 2.61-3.65). The risk of VTE in women taking first-, second- and third-generation OCs are 3.5 fold (OR=3.48; 95% CI: 2.01-4.94), 3 fold (OR=3.08; 95% CI: 2.43-3.74) and 4.3 fold (OR=4.35; CI: 3.69‒5.01), respectively. Conclusion: It seems that the risk of VTE is not same between different generations of OCs, so that third-generation has highest risk. Taking second and third-generation OCs increases the risk of VTE up to 3 and 4.3 fold, respectively. The researchers of the present study suggest that more trials be designed in relation to the effect of newer generations of OCs in different communities.- Oral contraceptives
- venous thromboembolism
- intracranial thrombosis
- pulmonary embolism
- meta-analysis
How to Cite
References
Rosendaal FR. Risk factors for venous thrombosis: prevalence, risk, and interaction. Semin Hematol. 1997;34(3):171-6.
Legnani C, Palareti G, Guazzaloca G, et al. Venous thromboembolism in young women. Role of thrombophilic mutations and oral contraceptive use. Eur Heart J. 2002;23 (12):984-90.
SantamarÃa A, Mateo J, Oliver A, et al. Risk of thrombosis associated with oral contraceptives of women from 97 families with inherited thrombophilia: high risk of thrombosis in carriers of the G20210A mutation of the prothrombin gene. Haematologica. 2001;86(9):965-71.
Sidney S, Petitti DB, Soff GA, Cundiff DL, Tolan KK, Quesenberry Jr CP. Venous thromboembolic disease in users of low-estrogen combined estrogen-progestin oral contracep-tives. Contraception. 2004;70(1):3-10.
Rott H. Thrombotic risks of oral contraceptives. Curr Opin Obstet Gynecol. 2012;24(4):235-40.
Szarewski A. Combined oral contraceptive pill and venous thromboembolism. Expert Rev Obstet Gynecol. 2011;6(5): 473-6.
Hosseini M, Taslimi S, Yousefifard M, et al. Serum Cholesterol Level Nomograms for Iranian Population; Suggestion for National Cut-Offs. Iran J public health. 2013;42 (2):164-71.
Hosseini M, Yousefifard M, Taslimi S, et al. Trend of blood cholesterol level in iran: results of four national surveys during 1991-2008. Acta Med Iran. 2013;51(9):642-51.
Mosher WD, Jones J. Use of contraception in the United States: 1982-2008. Vital health stat. 2010;23(29):1-44.
Disease WSGoC, Contraception SH. Cardiovascular Disease and Steroid Hormone Contraception: Report of a WHO Scientific Group: World Health Organization; 1998.
Urrutia RP, Coeytaux RR, McBroom AJ, et al. Risk of Acute Thromboembolic Events With Oral Contraceptive Use: A Systematic Review and Meta-analysis. Obstet Gynecol. 2013; 122(2):380-9.
Roach R, Lijfering W, Helmerhorst F, Cannegieter S, Rosendaal F, van Hylckama Vlieg A. The risk of venous thrombosis in women over 50 years old using oral contracept-ion or postmenopausal hormone therapy. J Thromb Haemost. 2013;11(1):124-31.
Wu O, Robertson L, Langhorne P, et al. Oral contraceptives, hormone replacement therapy, thrombophilias and risk of venous thromboembolism: a systematic review The Thrombosis: Risk and Economic Assessment of Thromboph-ilia Screening (TREATS) Study. Thromb Haemost. 2005;94(1): 17-25.
Lidegaard Ø, Edström B, Kreiner S. Oral contraceptives and venous thromboembolism: a five-year national case-control study. Contraception. 2002;65(3):187-96.
Canonico M, Plu-Bureau G, Lowe G, Scarabin P-Y. Hormone replacement therapy and risk of venous thromboembolism in postmenopausal women: systematic review and meta-analysis. BMJ. 2008;336(7655):1227-31.
Miller J, Chan BK, Nelson HD. Postmenopausal Estrogen Replacement and Risk for Venous ThromboembolismA Systematic Review and Meta-Analysis for the US Preventive Services Task Force. Ann Intern Med. 2002;136(9):680-90.
Vercellini P, Eskenazi B, Consonni D, et al. Oral contrace-ptives and risk of endometriosis: a systematic review and meta-analysis. Hum Reprod Update. 2011;17(2):159-70.
World Health Organization. WHO Medical Eligibility Criteria for Contraceptive Use: World Health Organization; 2010.
Suissa S, Spitzer W, Rainville B, Cusson J, Lewis M, Heinemann L. Recurrent use of newer oral contraceptives and the risk of venous thromboembolism. Hum Reprod. 2000;15 (4):817-21.
Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemi-ology (MOOSE) group. JAMA. 2000;283(15):2008-12.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264-9.
Huerta C, Johansson S, Wallander M-A, Garcia Rodriguez LA. Risk factors and short-term mortality of venous thromb-oembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med. 2007;167(9):935-44.
Lidegaard Ø, Løkkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboem-bolism: national follow-up study. BMJ: British Medical Journal. 2009;339:b2890.
Lidegaard Ø, Nielsen LH, Skovlund CW, Skjeldestad FE, Løkkegaard E. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9. BMJ. 2011; 343:d6423.
Austin H, Lally C, Benson JM, Whitsett C, Hooper WC, Key NS. Hormonal contraception, sickle cell trait, and risk for venous thromboembolism among African American women. Am J Obstet Gynecol. 2009;200(6):620.e1-.e3.
Aznar J, Vayá A, Estellés A, et al. Risk of venous thrombosis in carriers of the prothrombin G20210A variant and factor V Leiden and their interaction with oral contraceptives. Haema-tologica. 2000;85(12):1271-6.
Bloemenkamp KW, Rosendaal FR, Helmerhorst FM, Vandenbroucke JP. Higher risk of venous thrombosis during early use of oral contraceptives in women with inherited clotting defects. Arch Intern Med. 2000;160(1):49-58.
Dinger J, Bardenheuer K, Moehner S. The risk of venous thromboembolism in users of a drospirenone-containing oral contraceptive with a 24-day regimen – results from the INAS-OC Study. Fertil Steril. 2010;94(4, Supplement):S3.
Heinemann LAJ, Dinger JC, Assmann A, Minh TD. Use of oral contraceptives containing gestodene and risk of venous thromboembolism: outlook 10 years after the third-generation “pill scareâ€. Contraception. 2010;81(5):401-7.
Heinemann LAJ, Lewis MA, Assmann A, Thiel C. Case-control studies on venous thromboembolism: bias due to design? A methodological study on venous thromboembolism and steroid hormone use. Contraception. 2002;65(3):207-14.
Pomp ER, Rosendaal FR, Doggen CJ. Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use. Am J Hematol. 2008;83(2):97-102.
van Hylckama Vlieg A, Helmerhorst F, Vandenbroucke J, Doggen C, Rosendaal F. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. BMJ. 2009;339.
Bergendal A, Bremme K, Hedenmalm K, et al. Risk factors for venous thromboembolism in pre-and postmenopausal women. Thromb Res. 2012;130(4):596-601.
Barsoum MK, Heit JA, Ashrani AA, Leibson CL, Petterson TM, Bailey KR. Is progestin an independent risk factor for incident venous thromboembolism? A population-based case-control study. Thromb Res. 2010;126(5):373-8.
Smith N, Heckbert S, Lemaitre R, et al. sterified Estrogens and Conjugated Equine Estrogens and the Risk of Venous Thrombosis. JAMA. 2004;292(13 ):1581-7.
Spannagl M, Heinemann L, Schramm W. Are factor V Leiden carriers who use oral contraceptives at extreme risk for venous thromboembolism? Eur J of Contracep Reprod Healthcare. 2000;5(2):105-12.
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629-34.
Duval S, Tweedie R. A nonparametric “trim and fill†method of accounting for publication bias in meta-analysis. J Am Stat Assoc. 2000;95(449):89-98.
Sutton AJ, Duval S, Tweedie R, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta-analyses. BMJ. 2000;320(7249):1574-7.
Agency for Healthcare Research and Quality. Methods guide for effectiveness and comparative effectiveness reviews: Agency for Healthcare Research and Quality; 2012. Available at:. Accessed , 2012; 2012 [cited 2012 September 12]. Available from: www.effectivehealthcare.ahrq.gov.
Wu C, Grandi S, Filion K, Abenhaim H, Joseph L, Eisenberg M. Drospirenoneâ€containing oral contraceptive pills and the risk of venous and arterial thrombosis: a systematic review. Int J Obstet Gynaecol. 2013;120(7):801-11.
Kemmeren JM, Algra A, Grobbee DE. Third generation oral contraceptives and risk of venous thrombosis: meta-analysis. BMJ. 2001;323(7305):131-9.
MartÃnez F, RamÃrez I, Pérez-Campos E, Latorre K, Lete I. Venous and pulmonary thromboembolism and combined hormonal contraceptives. Systematic review and meta-analysis. Eur J of Contracep Reprod Healthcare. 2012;17(1):7-29.
Dinger JC, Heinemann LAJ, Kühl-Habich D. The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance study on Oral Contraceptiv-es based on 142,475 women-years of observation. Contracep-tion. 2007;75(5):344-54.
Jick SS, Hernandez RK. Risk of non-fatal venous throm-boembolism in women using oral contraceptives containing drospirenone compared with women using oral contracept-ives containing levonorgestrel: case-control study using Unit-ed States claims data. BMJ. 2011;342:d2151.
Parkin L, Sharples K, Hernandez RK, Jick SS. Risk of venous thromboembolism in users of oral contraceptives containing drospirenone or levonorgestrel: nested case-control study based on UK General Practice Research Database. BMJ. 2011;342:d2139.
Weber W. maastricht Study on risks of third Wim Weber generation pill “kept secret by industryâ€. The Lancet. 2001; 357(9258):779-85.
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