Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception: a Cochrane systematic review

Abstract

BackgroundThe coronavirus disease COVID-19 is associated with an increased risk of thrombotic events. Individuals with COVID-19 using hormonal contraception could be at additional risk for thromboembolism, but evidence is sparse.MethodsWe conducted a systematic review on the risk of thromboembolism with hormonal contraception use in women aged 15–51 years with COVID-19. We searched multiple databases through March 2022, including all studies comparing outcomes of patients with COVID-19 using or not using hormonal contraception. We applied standard risk of bias tools to evaluate studies and GRADE methodology to assess certainty of evidence. Our primary outcomes were venous and arterial thromboembolism. Secondary outcomes included hospitalisation, acute respiratory distress syndrome, intubation, and mortality.ResultsOf 2119 studies screened, three comparative non-randomised studies of interventions (NRSIs) and two case series met the inclusion criteria. All studies had serious to critical risk of bias and low study quality. Overall, there may be little to no effect of combined hormonal contraception (CHC) use on odds of mortality for COVID-19-positive patients (OR 1.0, 95% CI 0.41 to 2.4). The odds of hospitalisation for COVID-19-positive CHC users may be slightly decreased compared with non-users for patients with body mass index <35 kg/m2(OR 0.79, 95% CI 0.64 to 0.97). Use of any type of hormonal contraception may have little to no effect on hospitalisation rates for COVID-19-positive individuals (OR 0.99, 95% CI 0.68 to 1.44).ConclusionsNot enough evidence exists to draw conclusions regarding risk of thromboembolism in patients with COVID-19 using hormonal contraception. Evidence suggests there may be little to no or slightly decreased odds of hospitalisation, and little to no effect on odds of mortality for hormonal contraception users versus non-users with COVID-19.

Estrogen‐based hormonal therapy and the risk of thrombosis in COVID‐19 patients

“…At present, there is no consensus regarding the optimal management of ECT (i.e., whether to continue or hold) during significant infection, and recommendations are primarily based on expert opinion and clinical extrapolation. 23 Interestingly, epidemiologic data have shown that women have superior outcomes from COVID-19 infection compared to men, attributed in part to higher levels of estrogen and progesterone. 24 Both estrogen and progesterone are known to be potent immunomodulators and may play a role in mitigating the adverse effects associated with COVID-19 infection.…”