Effect of the injectable contraceptive depot‐medroxyprogesterone acetate on coagulation parameters in new users

Melhado-Kimura, Vaneska; Bizzacchi, Joyce Maria Annichino; Quaino, Susan Kelly Picoli; Montalvão, Silmara Lima; Bahamondes, Luís; Fernandes, Arlete

doi:10.1111/jog.13306

Cited by 6 publications

(2 citation statements)

References 20 publications

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“…Progestogens as a class have not been associated with acute prothrombotic changes, but effects may vary by type. 33,[42][43][44][45] Oral norethindrone and oral norethindrone acetate are uniquely metabolized to ethinyl estradiol at 0.2-1% of the orally administered dose. [46][47][48] Approved dosing for oral norethindrone acetate at 5-15 mg/day approximates at least 10-30 micrograms/day of oral ethinyl estradiol, typical contraceptive doses.…”

Section: Discussionmentioning

confidence: 99%

Association of Progestogens and Venous Thromboembolism Among Women of Reproductive Age

Cockrum

Soo

Ham

et al. 2022

Obstetrics &Amp; Gynecology

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To evaluate associations between use of seven progestogens and incident acute venous thromboembolism (VTE) among women of reproductive age.METHODS: This nested matched case-control study identified women aged 15-49 years from January 1, 2010, through October 8, 2018, in the IBM MarketScan databases, a nationwide sample of private insurance claims in the United States. After exclusions, 21,405 women with incident acute VTE (case group), identified by diagnosis codes, were matched 1:5 by year of birth and index date through risk set sampling to 107,025 women without prior VTE (control group). From lowest to highest systemic dose based on a modified hierarchy, progestogens studied were levonorgestrel-releasing intrauterine device (LNG-IUD), oral norethindrone, etonogestrel implant, oral progesterone, oral medroxyprogesterone acetate, oral norethindrone acetate, and depot medroxyprogesterone acetate (DMPA). Conditional logistic regression models adjusted for 16 VTE risk factors were used to estimate odds ratios and 99% CIs for incident acute VTE associated with current progestogen use compared with nonuse. The primary analysis treated each progestogen as a binary exposure. Dose, which varied for oral formulations, and chronicity were explored separately. Significance was set at P ,.01 to allow for multiple comparisons. RESULTS: Current use of higher-dose progestogens was significantly associated with increased odds of VTE compared with nonuse (oral norethindrone acetate: adjusted odds ratio [aOR] 3.00, 99% CI 1.96-4.59; DMPA: aOR 2.37, 99% CI 1.95-2.88; and oral medroxyprogesterone acetate: aOR 1.98, 99% CI 1.41-2.80). Current use of other progestogens was not significantly different from nonuse (LNG-IUD, etonogestrel implant, and oral progesterone) or had reduced odds of VTE (oral norethindrone). Sensitivity analyses that assessed misclassification bias supported the primary findings. CONCLUSION: Among reproductive-aged women using one of seven progestogens, only use of norethindrone acetate and medroxyprogesterone acetate-considered higher-dose progestogens-was significantly associated with increased odds of incident acute VTE. The roles of progestogen type, dose, and indication for use warrant further study.

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Section: Discussionmentioning

confidence: 99%

Association of Progestogens and Venous Thromboembolism Among Women of Reproductive Age

Cockrum

Soo

Ham

et al. 2022

Obstetrics &Amp; Gynecology

View full text Add to dashboard Cite

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“…Depot medroxyprogesterone acetate has been found to have varying effects on coagulation parameters; however, clinical effects are not clear. 19,20 In addition, it is not clear whether biological effects of progestins might interact with mechanisms related to postpartum thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism Among Women Initiating Depot Medroxyprogesterone Acetate Immediately Postpartum

Tepper

Jeng

Curtis

et al. 2019

Obstetrics &Amp; Gynecology

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has been reviewed by the Editorial Board and by special expert referees. Although it is judged not acceptable for publication in Obstetrics & Gynecology in its present form, we would be willing to give further consideration to a revised version. If you wish to consider revising your manuscript, you will first need to study carefully the enclosed reports submitted by the referees and editors. Each point raised requires a response, by either revising your manuscript or making a clear and convincing argument as to why no revision is needed. To facilitate our review, we prefer that the cover letter include the comments made by the reviewers and the editor followed by your response. The revised manuscript should indicate the position of all changes made. We suggest that you use the "track changes" feature in your word processing software to do so (rather than strikethrough or underline formatting).

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Obesity and contraception

Damodaran¹,

Swaminathan²

2020

Obesity and Gynecology

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Effect of the injectable contraceptive depot‐medroxyprogesterone acetate on coagulation parameters in new users

Abstract: Lower D-dimer and longer time to peak thrombin generation in new users of DMPA suggest a positive profile against hypercoagulability.

Cited by 6 publications

References 20 publications

Association of Progestogens and Venous Thromboembolism Among Women of Reproductive Age

Association of Progestogens and Venous Thromboembolism Among Women of Reproductive Age

Venous Thromboembolism Among Women Initiating Depot Medroxyprogesterone Acetate Immediately Postpartum

Obesity and contraception

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