Estimate of Venous Thromboembolism and Related-Deaths Attributable to the Use of Combined Oral Contraceptives in France

Abstract

PurposeTo estimate the number of venous thromboembolic events and related-premature mortality (including immediate in-hospital lethality) attributable to the use of combined oral contraceptives in women aged 15 to 49 years-old between 2000 and 2011 in France.MethodsFrench data on sales of combined oral contraceptives and on contraception behaviours from two national surveys conducted in 2000 and 2010 were combined to estimate the number of exposed women according to contraceptives generation and age. Absolute risk of first time venous thromboembolism in non-users of hormonal contraception and increased risk of thromboembolism in users vs. non-users of hormonal contraception were estimated on the basis of literature data. Finally, immediate in-hospital lethality due to pulmonary embolism and premature mortality due to recurrent venous thromboembolism were estimated from the French national database of hospitalisation and literature data.ResultsIn France, more than four million women are daily exposed to combined oral contraceptives. The mean annual number of venous thromboembolic events attributable to their use was 2,529 (778 associated to the use of first- and second-generation contraceptives and 1,751 to the use of third- and fourth-generation contraceptives), corresponding to 20 premature deaths (six with first- and second-generation contraceptives and fourteen with third- and fourth-generation contraceptives), of which there were eight to nine immediate in-hospital deaths. As compared to the use of first- and second-generation contraceptives, exposure to third- and fourth-generation contraceptives led to a mean annual excess of 1,167 venous thromboembolic events and nine premature deaths (including three immediate in-hospital deaths).ConclusionsCorrective actions should be considered to limit exposure to third- and fourth-generation contraceptives, and thus optimise the benefit-risk ratio of combined oral contraception.

The incidence and prognosis of thromboembolism associated with oral contraceptives: Age‐dependent difference in Japanese population

“…Mortality rates in the acute phase of cardiovascular events have decreased, but the disease burden remains high in the increasing number of survivors . Maino et al .…”

“…In France, more than 4 million women are daily exposed to COCs . The mean annual number of premature deaths attributable to their use was 20.…”

“…27 Mortality rates in the acute phase of cardiovascular events have decreased, but the disease burden remains high in the increasing number of survivors. 28 Maino et al stated that young women who survived a cardiovascular event have a high long-term mortality and morbidity when compared with the general population. 29 We revealed in this study that the thromboembolic events were the most frequent in the 40s, and the ATE ratio for overall thromboembolism tended to increase with advancing age (P = 0.0041).…”

“…In France, more than 4 million women are daily exposed to COCs. 28 The mean annual number of premature deaths attributable to their use was 20. As compared to the use of firstand second-generation COCs, exposure to third-and fourth-generation COCs led to a mean annual excess of nine premature deaths.…”

Schwerwiegende thrombembolische Ereignisse bei jugendlichen Erstanwenderinnen oraler Kontrazeption

“…Dulíček, 2009 (6) Dinger, 2010 (5) Lidegaard, 2011 (11) Botzenhardt, 2013 (2) Tricotel, 2014 (17) Vinogradova, 2015 ( • 56,75 % Auftreten einer VTE ohne Risikofaktoren außer der Einnahme oraler Kontrazeptiva,…”