Limited knowledge on progestogen‐only contraception and risk of venous thromboembolism

Bergendal, Annica; Odlind, Viveca; Persson, Ingemar; Kieler, Helle

doi:10.1080/00016340902730375

Cited by 39 publications

(18 citation statements)

References 26 publications

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“…4,6,18 As previously described, the risk for venous thromboembolism was most pronounced during the first 3 months of treatment and declined by time. 4,12,13,27,28 In line with what has previously been reported, we found an increased risk for venous thromboembolism in association with use of "high-dose" progestogen-only contraception (depot injectables). 3,4,6 We had the possibility to address important confounding factors and the increased differential risks appear to be independent of BMI, smoking, and immobilization.…”

Section: Discussionsupporting

confidence: 89%

“…12 All current users of combined hormonal contraception and progestogenonly contraception were categorized by length of use and divided into three categories: 3 months or less, 3-12 months, and more than 12 months. 12 All current users of combined hormonal contraception and progestogenonly contraception were categorized by length of use and divided into three categories: 3 months or less, 3-12 months, and more than 12 months.…”

Section: Methodsmentioning

confidence: 99%

“…7 For women carrying the thrombophilic genetic factor V Leiden and the prothrombin gene mutation, the reported risks are based on few cases and risks vary greatly. [12][13][14] The aims of this nationwide case-control study (Thrombo Embolism Hormone Study) were to investigate associations between hormonal contraception and risks of venous thromboembolism with a focus on type of progestogen while considering important confounders such as BMI and smoking and further to study the influences of carriership of targeted genetic variants. 9,10 Currently, thrombophilia screening is considered as not cost-effective before prescribing combined hormonal contraceptives.…”

Section: Level Of Evidence: IImentioning

confidence: 99%

See 2 more Smart Citations

Association of Venous Thromboembolism With Hormonal Contraception and Thrombophilic Genotypes

Bergendal

Persson

Odeberg

et al. 2014

Obstetrics &Amp; Gynecology

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Section: Level Of Evidence: IImentioning

confidence: 99%

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Association of Venous Thromboembolism With Hormonal Contraception and Thrombophilic Genotypes

Bergendal

Persson

Odeberg

et al. 2014

Obstetrics &Amp; Gynecology

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“…In most of the reviews the results of the adverse effects estimates agreed between types of study design [52], [58]–[60], [63], [65]–[67], [69]–[84]. Most reviews that demonstrated an agreement between study designs did not find a significant increase or significant decrease in the adverse effects under investigation (Table 2).…”

Section: Resultsmentioning

confidence: 98%

“…Most (27/29, 93%) focused on adverse effects of pharmacological interventions (such as oral contraceptives, NSAIDs, or HRT) [58]–[71], [72], [73]–[84]. Other topics assessed were a surgical intervention (caesarean delivery) [85], and a diagnostic test (ultrasonography) [52].…”

Section: Resultsmentioning

confidence: 99%

Comparison of Pooled Risk Estimates for Adverse Effects from Different Observational Study Designs: Methodological Overview

2013

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BackgroundA diverse range of study designs (e.g. case-control or cohort) are used in the evaluation of adverse effects. We aimed to ascertain whether the risk estimates from meta-analyses of case-control studies differ from that of other study designs.MethodsSearches were carried out in 10 databases in addition to reference checking, contacting experts, and handsearching key journals and conference proceedings. Studies were included where a pooled relative measure of an adverse effect (odds ratio or risk ratio) from case-control studies could be directly compared with the pooled estimate for the same adverse effect arising from other types of observational studies.ResultsWe included 82 meta-analyses. Pooled estimates of harm from the different study designs had 95% confidence intervals that overlapped in 78/82 instances (95%). Of the 23 cases of discrepant findings (significant harm identified in meta-analysis of one type of study design, but not with the other study design), 16 (70%) stemmed from significantly elevated pooled estimates from case-control studies. There was associated evidence of funnel plot asymmetry consistent with higher risk estimates from case-control studies. On average, cohort or cross-sectional studies yielded pooled odds ratios 0.94 (95% CI 0.88–1.00) times lower than that from case-control studies.InterpretationEmpirical evidence from this overview indicates that meta-analysis of case-control studies tend to give slightly higher estimates of harm as compared to meta-analyses of other observational studies. However it is impossible to rule out potential confounding from differences in drug dose, duration and populations when comparing between study designs.

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A systematic review and meta‐analysis of venous thrombosis risk among users of combined oral contraception

Dragoman

Tepper

et al. 2018

Intl J Gynecology & Obste

187

100

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BackgroundCombined oral contraceptives (COCs) containing various progestogens could be associated with differential risks for venous thromboembolism (VTE).ObjectiveTo evaluate the comparative risks of VTE associated with the use of low‐dose (less than 50 μg ethinyl estradiol) COCs containing different progestogens.Search strategyPubMed and the Cochrane Library were searched from database inception through September 15, 2016, by combining search terms for oral contraception and venous thrombosis.Selection criteriaStudies reporting VTE risk estimates among healthy users of progestogen‐containing low‐dose COCs were included.Data collection and analysisA random‐effects model was used to generate pooled adjusted risk ratios and 95% confidence intervals; subgroup and sensitivity analyses assessed the impact of monophasic‐COC use and study‐level characteristics.Main resultsThere were 22 articles included in the analysis. The use of COCs containing cyproterone acetate, desogestrel, drospirenone, or gestodene was associated with a significantly increased risk of VTE compared with the use of levonorgestrel‐containing COCs (pooled risk ratios 1.5–2.0). The analysis restricted to monophasic COC formulations with 30 μg of ethinyl estradiol yielded similar findings. After adjustment for study characteristics, the risk estimates were slightly attenuated.ConclusionsCompared with the use of levonorgestrel‐containing COCs, the use of COCs containing other progestogens could be associated with a small increase in risk for VTE.

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Limited knowledge on progestogen‐only contraception and risk of venous thromboembolism

Cited by 39 publications

References 26 publications

Association of Venous Thromboembolism With Hormonal Contraception and Thrombophilic Genotypes

Association of Venous Thromboembolism With Hormonal Contraception and Thrombophilic Genotypes

Comparison of Pooled Risk Estimates for Adverse Effects from Different Observational Study Designs: Methodological Overview

A systematic review and meta‐analysis of venous thrombosis risk among users of combined oral contraception

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