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

Abstract

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.

Transgender patients and the role of the coagulation clinician

“…The VTE risk is dependent on the estrogen dose, with higher doses associated with increased risk . The progestin agents desogestrel, drospirenone, and cyproterone acetate further increase the risk compared to levonorgestrel for a given estrogen dose . Many patient‐specific factors such as obesity, smoking, and inherited thrombophilias can result in a synergistic increase in VTE risk for ciswomen using COC …”

“…9 The progestin agents desogestrel, drospirenone, and cyproterone acetate further increase the risk compared to levonorgestrel for a given estrogen dose. 11 Many patient-specific factors such as obesity, smoking, and inherited thrombophilias can result in a synergistic increase in VTE risk for ciswomen using COC. [12][13][14] Although the relative risk increase of VTE associated with HRT is lower than for COC, it is not negligible.…”

FSRH Guideline (January 2019, amended October 2023) Combined Hormonal Contraception

“…A systematic review identified no relevant RCTs 230. Meta-analysis230 of the data from observational studies (which may be subject to confounding and prescribing bias) indicated that use of low-dose COC (<50 μg EE) containing cyproterone acetate, desogestrel, gestodene or DRSP was associated with a significant 1.5- to 2-fold risk of VTE compared to use of COC containing LNG.…”

Risk Factors of Thrombotic Complications in Women Using Combined Hormonal Contraceptives

“…По данным Всемирной организации здравоохранения, в настоящее время комбинированная гормональная контрацепция является эффективным и широко применяемым методом во всем мире, около 104 миллионов женщин ежегодно используют ее с противозачаточной и лечебной целью [1][2][3][4]. Абсолютный риск развития тромбоза среди пациенток, принимающих современные комбинированные гормональные контрацептивы (КГК), низкий, но вместе с тем он в 3-6 раз выше в сравнении с женщинами, не использующими КГК [1][2][3].…”

“…Абсолютный риск развития тромбоза среди пациенток, принимающих современные комбинированные гормональные контрацептивы (КГК), низкий, но вместе с тем он в 3-6 раз выше в сравнении с женщинами, не использующими КГК [1][2][3]. По данным эпидемиологических исследований, риск венозного тромбоэмболизма (ВТЭ) у женщин, использующих КГК, варьирует в диапазоне 3-9/10000 человеко-лет [4], риск артериальных тромботических осложнений еще ниже и составляет от 0,9 до 3,5/10000 человеко-лет [5]. Установлена обратная зависимость риска тромбозов от дозы эстрогенового компонента, но дискутабельна зависимость от типа прогестина [6].…”