Stroke in Users of Low-Dose Oral Contraceptives

Petitti, Diana B.; Sidney, Stephen; Bernstein, Allan L.; Wolf, Sheldon M.; Quesenberry, Charles; Ziel, Harry K.

doi:10.1056/nejm199607043350102

Cited by 317 publications

(95 citation statements)

References 27 publications

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“…Previous studies have reported a several-fold increase in stroke susceptibility when several abnormalities in the risk profile are concomitant [4, 6, 28]. For example, females aged >35 years may be prone to stroke when they take OCs and smoke [29, 30]. In our study, although all the 14 women on OC were using relatively low-dose oestrogen (30 to 35 µg) formulations, 10 of them (71.4%) were ≥35 years old, nine (64.3%) smoked and five (35.7%) had migraine history.…”

Section: Discussionmentioning

confidence: 99%

Ischaemic Stroke in Young People: A Prospective and Long-Term Follow-Up Study

Musolino¹,

Spina²,

Granata

et al. 2003

Cerebrovasc Dis

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Background: A few studies have comprehensively assessed the epidemiology, aetiology, prognosis, and secondary prevention of ischaemic stroke in young adults. To gain further information on this field, we have prospectively studied a hospital-based series of young adults with a first-ever episode of cerebral ischaemia (CI). Methods: Sixty consecutive patients aged 17–45 with ischaemic stroke (55 patients) or transient ischaemic attack within 24 h before hospital admission were recruited and investigated by a standardized rigorous protocol. The patients were followed up for ≧1 year after hospital discharge. Arbitrary doses of aspirin 100 mg/d or ticlopidine 250 mg b.i.d. in case of intolerance to aspirin were given for the secondary prevention. Adjusted-dose oral anticoagulation (INR target 2.5) was used in the presence of cardioembolism or hypercoagulable states. Endpoints included the residual disability, rated by modified Rankin Scale (RS) and Barthel Index (BI), and poststroke recurrence. Results: CI was associated with two or more risk factors in 61.6% of patients. Cigarette smoking was more frequently associated with male gender (p < 0.05) and migraine history with female sex (p < 0.05). The atherothrombotic diagnostic subtype and the subtype from ‘other cause’ predominated significantly among patients ≧35 years old (p < 0.05) and <35 years (p < 0.025), respectively. The ‘other cause’ subset was more frequent in female gender (p < 0.05). Transoesophageal echocardiography (TEE) detected potential cardiac sources of emboli (PCSE) at an extent 3 times higher (p < 0.0001) than transthoracic echocardiography. Congenital heart defects were nearly threefold more frequent than acquired ones, with a prevalence of patent foramen ovale. At a mean of 6.1 ± 2.6 years (confidence interval 5.4 to 6.8), follow-up data were available for only 54 patients, since five patients were lost and one died in the acute phase. Poststroke recurrence rate was low (7.4%) and no event was fatal. General handicap was severe to moderately severe (RS>3) in 11% of the patients, slight to moderate (1≧RS≤3) in 59% and absent in 30% (RS = 0). Functional disability was relatively low with 50% of the patients independent (BI ≧95), 38.9% partially dependent (BI 60 to 86), and 11.1% fully dependent (BI <60). Thirty-seven (68.5%) patients returned to work, although adjustments (other job or part-time employment) were necessary for 10 out of them (27%). Conclusions: The present study, though limited by the relatively small number of subjects, suggests that the overall prognosis of ischaemic stroke in young adults is good. We strongly recommend TEE in all patients with ischaemic stroke as an essential tool to increase the detection of PCSE and make the therapeutic approach more efficient.

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Section: Discussionmentioning

confidence: 99%

Ischaemic Stroke in Young People: A Prospective and Long-Term Follow-Up Study

Musolino¹,

Spina²,

Granata

et al. 2003

Cerebrovasc Dis

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“…In contrast, US studies of the past 25 years have failed to demonstrate an increased risk of stroke associated with CHCs. One large study reviewing 3.6 million women-years of use found no increased risk of ischemic stroke (OR, 0.96) with current low-dose OCs [14], nor did a pooled analysis of US studies [15].…”

Section: Chc Treatment Considerationsmentioning

confidence: 99%

Hormonal therapies for menstrual migraine

Calhoun

Hutchinson²

2009

Current Science Inc

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Menstrual-related migraine (MRM) affects the majority of female migraineurs, with menstrual-associated attacks reported to be more disabling, longer lasting, and less responsive to traditional treatments than nonmenstrual attacks. Emerging evidence suggests that minimizing or eliminating monthly declines in estrogen concentration may be effective in preventing MRM. This article gives a practical overview of current hormonal options, both contraceptive and noncontraceptive. Our intent is to help the reader better understand the differences in currently available formulations and how some of these agents may be utilized as hormonal preventives of MRM.

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“…The few studies of young Asian ischemic stroke report a high male preponderance of 71–76% [8,9,12] compared to Europe’s 44–60% [13,14]. Apart from hypertension, diabetes mellitus (DM) and heart disease, other important risk factors for stroke in young women include smoking [15], oral contraceptives [16] and heavy alcohol consumption [17]. Pregnancy and postpartum stroke is either rare [13] or excluded [18].…”

Section: Introductionmentioning

confidence: 99%

Ischemic Stroke in Young Asian Women: Risk Factors, Subtypes and Outcome

Wasay

Kaul

Menon³

et al. 2010

Cerebrovasc Dis

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Background and Objective: The objective of our study was to describe risk factors, mechanisms and outcome of young Asian women with ischemic stroke. Methods: Twelve tertiary-care centers in 8 Asian countries participated. Women aged 15–45 years were included if they had an ischemic stroke supported by neuroimaging. Data on age, risk factor history, stroke mechanism and discharge status were collected. Results: A total of 958 subjects were included, their mean age was 34 years. Large-vessel thrombosis comprised 24%, cerebral venous thrombosis 21%, cardioembolism 19% and small-vessel thrombosis 15%. The stroke risk factors included hypertension (29%), diabetes (14%), pregnancy (11%), valvular heart disease (10%) and cigarette smoking (3%). Anemia was found in 42%, and mortality was 4%; at discharge, 17% had modified Rankin score (mRS) >4 and 83% mRS 0–3. Conclusion: Unlike among Caucasians, large-vessel thrombosis, cerebral venous thrombosis and cardioembolism are common among young Asian women with stroke. A high proportion are pregnancy-related. More studies are needed.

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Stroke in Users of Low-Dose Oral Contraceptives

Abstract: Stroke is rare among women of childbearing age. Low-estrogen oral-contraceptive preparations do not appear to increase the risk of stroke.

Cited by 317 publications

References 27 publications

Ischaemic Stroke in Young People: A Prospective and Long-Term Follow-Up Study

Ischaemic Stroke in Young People: A Prospective and Long-Term Follow-Up Study

Hormonal therapies for menstrual migraine

Ischemic Stroke in Young Asian Women: Risk Factors, Subtypes and Outcome

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