Risk of recurrence in women with venous thromboembolism related to estrogen‐containing contraceptives: Systematic review and meta‐analysis

Abstract

Background The risk of recurrence after a venous thromboembolism (VTE) related to estrogen‐containing contraceptives is a key driver to guide anticoagulant treatment decisions. Objective To estimate the incidence rate of recurrent VTE after discontinuation of anticoagulant treatment in women with a first episode of VTE related to estrogen‐containing contraceptives. Methods Embase, MEDLINE, and the CENTRAL were searched from 1 January 2008 to 27 May 2021 for prospective and retrospective studies reporting on recurrence after a first VTE related to estrogen‐containing contraceptives. Risk of bias was assessed using QUIPS tool. Recurrence rates per 100 patient‐years were pooled using Knapp‐Hartung random‐effects meta‐analysis. Incidence rates were reported separately based on study follow‐up duration (≤1 year, 1–5 years, and >5 years) and for several subgroups. Results A total of 4,120 studies were identified, of which 14 were included. The pooled recurrence rate was 1.57 (95%‐CI: 1.10–2.23; I2 = 82%) per 100 patient‐years. Recurrence rates per 100 patient‐years were 2.73 (95%‐CI: 0.00–3643; I2 = 80%) for studies with ≤1 year follow‐up, 1.35 (95%‐CI: 0.68–2.68; I2 = 44%) for studies with 1–5 years follow‐up, and 1.42 (95%‐CI: 0.84–2.42; I2 = 78%) for studies with >5 years follow‐up. Conclusion Among women with VTE associated with estrogen‐containing contraceptives, the risk of recurrence after stopping anticoagulation is low, which favors short‐term anticoagulation. Large prospective studies on VTE recurrence rates and risk factors after stopping short‐term anticoagulants are needed.

From 3 months to forever – oral contraceptives, venous thrombosis and duration of anticoagulation. A challenging decision

“…The rate of recurrence reported is quite similar to another recent systematic review and meta‐analysis of 14 studies, which noted a rate of 1.57 per 100 patient‐years 7 …”

“…The rate of recurrence reported is quite similar to another recent systematic review and meta-analysis of 14 studies, which noted a rate of 1.57 per 100 patient-years. 7 The impact of the report by Abdulrehman et al is substantial. Clinicians treating young women who experience a VTE in the setting of use of an oestrogen-containing contraceptive can feel comfortable avoiding the unpalatable recommendation to continue anticoagulants for years.…”

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

“…The meta-analysis reported a low VTE recurrence (incidence per 100 patient-years, 1.57 [95% CI, 1.10–2.23]). 81…”

Pregnancy after Combined Oral Contraceptive-Associated Venous Thromboembolism: An International Retrospective Study of Outcomes

“…2 3 COCs increase the relative risk of VTE by three to six times and the magnitude of risk depends on the progestogen type and estrogen doses used. 4 5 Women who have their first VTE while taking oestrogens have a low risk of recurrent VTE after stopping anticoagulation 6 7 8 and might not benefit from extended anticoagulant therapy.…”