First-time use of newer oral contraceptives and the risk of venous thromboembolism

Suissa, Samy; Blais, Lucie; Spitzer, Walter O.; Cusson, Jean R.; Lewis, Michael Alexander Oxenham; Heinemann, L.

doi:10.1016/s0010-7824(97)00119-4

Cited by 180 publications

(108 citation statements)

References 16 publications

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“…On an absolute population risk basis, the baseline and testosterone induced increases in risks of venous thromboembolism in this population of middle aged and older men are quantitatively comparable to the baseline (non-user) risks of venous thromboembolism in women and the increase among users of oral oestrogens in combined oral contraceptives or oestrogen replacement therapy for menopause 2930 31 32 The early increase in risk in the first six months is also similar to that seen with oral oestrogen therapy 19. An increased risk of venous thromboembolism in patients with underlying familial or acquired thrombophilia if treated with testosterone has also been hypothesised and could explain the increased risk within six months after starting testosterone treatment 33…”

Section: Discussionmentioning

confidence: 58%

“…A cohort study and a case-control study did not show evidence of an association between testosterone use and an increased risk of venous thromboembolism 1718 None of the previous studies, however, investigated the timing and duration of testosterone use, which could have masked a risk of venous thromboembolism soon after the start of treatment, as seen with oral contraceptives 19…”

Section: Introductionmentioning

confidence: 98%

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Testosterone treatment and risk of venous thromboembolism: population based case-control study

Martínez¹,

Suissa

Rietbrock³

et al. 2016

BMJ

Self Cite

137

119

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Objective To determine the risk of venous thromboembolism associated with use of testosterone treatment in men, focusing particularly on the timing of the risk.Design Population based case-control studySetting 370 general practices in UK primary care with linked hospital discharge diagnoses and in-hospital procedures and information on all cause mortality.Participants 19 215 patients with confirmed venous thromboembolism (comprising deep venous thrombosis and pulmonary embolism) and 909 530 age matched controls from source population including more than 2.22 million men between January 2001 and May 2013.Exposure of interest Three mutually exclusive testosterone exposure groups were identified: current treatment, recent (but not current) treatment, and no treatment in the previous two years. Current treatment was subdivided into duration of more or less than six months.Main outcome measure Rate ratios of venous thromboembolism in association with current testosterone treatment compared with no treatment were estimated using conditional logistic regression and adjusted for comorbidities and all matching factors.Results The adjusted rate ratio of venous thromboembolism was 1.25 (95% confidence interval 0.94 to 1.66) for current versus no testosterone treatment. In the first six months of testosterone treatment, the rate ratio of venous thromboembolism was 1.63 (1.12 to 2.37), corresponding to 10.0 (1.9 to 21.6) additional venous thromboembolisms above the base rate of 15.8 per 10 000 person years. The rate ratio after more than six months’ treatment was 1.00 (0.68 to 1.47), and after treatment cessation it was 0.68 (0.43 to 1.07). Increased rate ratios within the first six months of treatment were observed in all strata: the rate ratio was 1.52 (0.94 to 2.46) for patients with pathological hypogonadism and 1.88 (1.02 to 3.45) for those without it, and 1.41 (0.82 to 2.41) for those with a known risk factor for venous thromboembolism and 1.91 (1.13 to 3.23) for those without one.Conclusions Starting testosterone treatment was associated with an increased risk of venous thromboembolism, which peaked within six months and declined thereafter.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 98%

Testosterone treatment and risk of venous thromboembolism: population based case-control study

Martínez¹,

Suissa

Rietbrock³

et al. 2016

BMJ

Self Cite

137

119

View full text Add to dashboard Cite

show abstract

“…We adjusted for most of the known clinical risk factors for venous thromboembolism that might have led to a change in prescription, but we did not have information about family history of this condition. Restricting our analysis to first-time users, to reduce indication bias (as was suggested by an earlier study 28 ), did not change the results. With the database system used for this study, we could not verify diagnoses by examining imaging data.…”

Section: Limitationsmentioning

confidence: 99%

Higher risk of venous thrombosis associated with drospirenone-containing oral contraceptives: a population-based cohort study

Gronich¹,

Lavi²,

Rennert³

2011

Canadian Medical Association Journal

118

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O ral hormonal therapy is the preferred method of contraception, especially among young women. In the United States in 2002, 12 million women were using "the pill."1 In a survey of households in Great Britain conducted in 2005 and 2006, onequarter of women aged 16 to 49 years of age were using this form of contraception.2 A large variety of combined oral contraceptive preparations are available, differing in terms of estrogen dose and in terms of the dose and type of the progestin component. Among preparations currently in use, the estrogen dose ranges from 15 to 35 µg, and the progestins are secondgeneration, third-generation or newer. The second-generation progestins (levonorgestrel and norgestrel), which are derivatives of testosterone, have differing degrees of androgenic and estrogenic activities. The structure of these

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“…12 Inclusion of prevalent or current drug users can lead to significant bias because patients who experience early intolerance or adverse effects of a drug may discontinue the drug, and the remaining cohort will consist of a healthier and usually more adherent group. 13 Risk that varies over time, whereby new users have a higher risk of an adverse event, has been observed for numerous associations, including those between nonsteroidal anti-inflammatory drugs and upper gastrointestinal bleeding, 14 oral contraceptives and venous thromboembolism, 15 benzodiazepines and falls, 16 and angiotensinconverting enzyme inhibitors and angioedema. 17 …”

Section: Selecting the Study Cohortmentioning

confidence: 99%

An Introduction to the Fundamentals of Cohort and Case–Control Studies

Gamble

2014

CJHP

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First-time use of newer oral contraceptives and the risk of venous thromboembolism

Cited by 180 publications

References 16 publications

Testosterone treatment and risk of venous thromboembolism: population based case-control study

Testosterone treatment and risk of venous thromboembolism: population based case-control study

Higher risk of venous thrombosis associated with drospirenone-containing oral contraceptives: a population-based cohort study

An Introduction to the Fundamentals of Cohort and Case–Control Studies

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