Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis

Bh, Stegeman; M, de Bastos; Fr, Rosendaal; A, van Hylckama Vlieg; Helmerhorst, FM; Stijnen, Theo; Dekkers, Olaf M.

doi:10.1136/bmj.f5298

Cited by 332 publications

(239 citation statements)

References 55 publications

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“…[10] The risk of VTE is dependent on the route of administration. There is lower associated risk with transdermal and intra-uterine hormonal therapy as well as the progesterone-only oral contraceptive.…”

Section: Oestrogen and Vte Riskmentioning

confidence: 99%

Recommendations for Thrombopropylaxis in Obstetrics and Gynaecology-A SASOG Guideline

et al. 2018

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RESEARCHBackground. Venous thromboembolism (VTE) is associated with considerable morbidity and mortality in the absence of thromboprophylaxis. Method. The Southern African Society of Thrombosis and Haemostasis reviewed the available literature and comprehensive evidencebased guidelines on the prevention of VTE in obstetrics and gynaecology. A draft document was produced and revised by consensus agreement by a panel of professionals from various specialties. The recommendations were adjudicated by an independent international expert to avoid local bias. Results and conclusion. We present concise, practical thromboprophylaxis guidelines for the clinical management of patients in obstetrics and gynaecology. Recommendations reflect current best practice, which it is hoped will lead to improved anticoagulation practice in this group of patients. Venous thromboembolism (VTE) is associated with considerable morbidity, and mortality in the absence of thromboprophylaxis. Pulmonary embolism (PE) is the leading cause of maternal death worldwide. S Afr J Obstet Gynaecol[1] Further, PE is the cause of ~20% of deaths following hysterectomy.[2] The prevalence of deep vein thrombosis (DVT) in patients having major gynaecologic surgery ranges between 15% and 40%. [3] There are a few randomised trials to guide the management of this group of patients. Recommendations in this guideline therefore reflect current best practice. Management should be individualised according to the risk-benefit ratio and cost. MethodsOn behalf of the Southern African Society of Thrombosis and Haemostasis, a representative guideline panel of professionals from various specialities reviewed the available literature on the prevention of VTE in obstetrics and gynaecology. Recommendations presented are in accordance with the more comprehensive evidence-based guidelines namely the 9th edition of the American College of Chest Physicians (ACCP), [4] the Green Top guidelines of the Royal College of Obstetricians and Gynaecologists (RCOG), [5] the American College of Obstetricians and Gynecologists (ACOG), [6] the Society of Obstetricians and Gynaecologists of Canada (SOGC), [7] Society of Obstetric Medicine of Australia and New Zealand (SOMANZ) [8] and the European Society of Regional Anaesthesia (ESRA) Guidelines on Anticoagulation and Regional Anaesthesia.[9] Many of these recommendations are formulated in the absence of strong evidence and the guidelines were also prepared in conjunction with systematic reviews and observational studies. A draft document was produced and revised by consensus agreement. The guidelines were adjudicated and co-authored by an independent international expert to avoid local bias. VTE in gynaecology Oestrogen and VTE riskOestrogen use increases the risk of VTE as a class effect which is dose dependant.[10] The risk of VTE is dependent on the route of administration. There is lower associated risk with transdermal and intra-uterine hormonal therapy as well as the progesterone-only oral contraceptive. [11,12] Gynaecological surgery...

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Section: Oestrogen and Vte Riskmentioning

confidence: 99%

Recommendations for Thrombopropylaxis in Obstetrics and Gynaecology-A SASOG Guideline

et al. 2018

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“…Although VTE risk is three to six times that in nonusers, the absolute risk is low and is less than the VTE risk associated with pregnancy and postpartum. Risk is related to both the dose of estrogen and the type of progestogen, 9,10 with an approximately two-fold higher risk for desogestrel/gestodene/drospirenone/cyproterone pills compared with levonorgestrel/norethisterone pills (see Table 2). 11 The risk is highest in the first year of use and declines thereafter but persists until discontinuation.…”

Section: Principal Risksmentioning

confidence: 99%

Efficacy and side‐effects of oral contraceptives

MacGregor¹

2017

Prescriber

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“…The considerable predicament we face with regard to COC and VT risk can be attributed to the vast number of women using COCs (Stegeman et al, 2013), not only for contraceptive purposes but also for its various noncontraceptive benefits. As such a vast number of females between the age of 15 and 44 years are using a drug therapy that is known to increase the risk of VT, a condition associated with increased disability and mortality, it is essential to determine the effect of COCs on blood clot formation.…”

Section: Supplementary Tablementioning

confidence: 99%

“…• The ten most commonly used COCs increase the risk of first VT: levenorgestrel (LNG) in combination with 20 µg EE poses the lowest risk, whereas DRSP combined with 30 µg EE, cyproterone acetate combined with 35 µg EE, and LNG combined with 50 µg EE poses the greatest risk of VT (Stegeman, 2013).…”

Section: Supplementary Tablementioning

confidence: 99%

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Synthetic Hormones and Clot Formation

2016

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Combined oral contraceptives (COCs), colloquially referred to as "the pill," have been regarded as a medical breakthrough, as they have improved the lives of countless women, from simplifying family planning to the treatment of acne, endometriosis, polycystic ovarian syndrome, and dysmenorrhea. Unfortunately, COC usage has been associated with an increased occurrence of venous thrombosis and therefore a systemic hypercoagulable state in susceptible females. Here we discuss the health risks of COC usage and use viscoelastic and morphological techniques to investigate the effect of different COC constituents on clot formation, particularly fibrin network packaging and whole blood viscoelasticity. Viscoelastic properties of whole blood showed gender-specific changes while morphological alterations were person-specific, regardless of gender. Using scanning electron microscopy and thromboelastography provides great insight regarding fibrin packaging and the development of a hypercoagulable state in high-risk individuals. We proposed a three-step approach where (1) an individual's coagulation profile baseline is determined, after which (2) the "ideal" combination of constituents is prescribed, and (3) the coagulation profile of the individual is monitored to assess possible risk of thrombosis. Only in following such an individualized patient-oriented approach will we be able to avoid the many health issues due to COC usage in susceptible females.

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Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis

Abstract: Objective To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives.Design Systematic review and network meta-analysis.

Cited by 332 publications

References 55 publications

Recommendations for Thrombopropylaxis in Obstetrics and Gynaecology-A SASOG Guideline

Recommendations for Thrombopropylaxis in Obstetrics and Gynaecology-A SASOG Guideline

Efficacy and side‐effects of oral contraceptives

Synthetic Hormones and Clot Formation

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