Hormonal contraceptives and venous thromboembolism: Are inflammatory bowel disease patients at increased risk? A retrospective study on a prospective database

Abstract

Recent studies showed an increased risk of venous thromboembolism (VTE) in patients receiving oral hormonal contraceptives. Inflammatory bowel diseases (IBD) often affect young patients and represent a pro-coagulant condition. This could result from active inflammation, but a potential role for genetic and molecular factors has been suggested. Hormonal contraceptives have also been associated with increased risk of VTE and the risk may be greater in IBD patients that already are in a pro-coagulant status, but no definitive data are available in this population. The purpose of our study was to seek for differences of the risk of VTE in IBD patients receiving hormonal contraceptives compared with controls.This is a retrospective study. We interrogated a prospectively maintained database of IBD patients observed at our outpatient clinic between 2000 and 2014. All female patients managed conservatively, with no active disease, who were taking oral hormone contraceptives in the study period, were included. Patients observed for other-than-IBD conditions at our Unit and at the Unit of Gynaecology and Obstetrics, receiving contraceptives, served as controls (ratio 1:2). Patients with cancer, those receiving hormonal therapy, and those with known genetic predisposition to VTE were excluded.We included 146 six IBD patients and 290 controls. One patient in each group developed VTE. Overall, the incidence of VTE associated with oral contraceptives was 0.5%. IBD was associated with increased risk of VTE (OR 1.9, 95% CI 0.12–32.12, p > 0.99). Active smokers since 10 years (17.2%) had higher risks of VTE (OR 8.6, 95% CI 1.16–19.25, p = 0.03).Our data show that patients with IBD in remission are not at higher risk of VTE due to oral oestrogen-containing contraceptives compared with non-IBD controls. Smokers are at increased risk, irrespective of the baseline disease.

Risk Factors of Venous Thromboembolism in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

“…The average age of the participants was as 44.59 ± 10.18 years. In three studies sample age was reported as a range ( 33 , 34 , 43 ), and four studies did not report the descriptive information concerning the age of their sample ( 22 , 26 , 32 , 35 ).…”

European Crohn’s and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation

“…In a retrospective study, oestrogen-based contraceptives were not associated with an additional risk for thromboembolism in women with IBD in remission when compared to controls. 32 As IBD is considered a thrombophilic condition, particularly when disease is active, 33 Contraceptive Use in 2016. 34 This document placed the use of combined hormonal therapy in IBD into a 'grey area', as they are generally regarded as safe except for women with an increased risk of venous thromboembolism, in whom the risks may outweigh the benefits.…”

Unique Considerations in Women with Inflammatory Bowel Disease

“…The risk for VTE in the general population is higher in those with OCP use compared to those without OCP use [14]. Pellino, et al conducted a retrospective review of an Italian IBD database and compared 146 IBD patients on OCP to 290 non-IBD matched controls [15]. They found no significant difference in the incidence of VTE between IBD patients in remission and in non-IBD patients [15].…”

“…Pellino, et al conducted a retrospective review of an Italian IBD database and compared 146 IBD patients on OCP to 290 non-IBD matched controls [15]. They found no significant difference in the incidence of VTE between IBD patients in remission and in non-IBD patients [15]. In general, there is likely little avoidance of estrogen-based contraception in usual clinical practice [16,17].…”