Third-generation oral contraceptives and venous thrombosis

Nr, Poulter; Chang, Choon Lan; Marmot, Michael; Farley, Tmm; Meirik, Olav

doi:10.1016/s0140-6736(05)60174-2

Cited by 22 publications

(5 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The higher doses of estrogen in fi rst-generation COCs were associated with higher rates of thromboembolic disease. Second-and third-generation formulations have been associated with less thromboembolic risk [10,11]. The thromboembolic risks of the newer formulations of COCs and nonoral formulations are not known.…”

Section: Combined Hormonal Contraceptivesmentioning

confidence: 99%

Choosing the best contraceptive method for the adult with congenital heart disease

Silversides

Sermer²,

Siu³

2009

Curr Cardiol Rep

View full text Add to dashboard Cite

As women with congenital heart disease (CHD) approach childbearing age, issues such as pregnancy and contraception need to be addressed. Women with CHD represent a heterogeneous population. While some have simple cardiac lesions and thus have contraceptive risks that are no different from those of the general population, others have complex, multisystem disease such that incorrect contraception advice can be associated with serious health consequences. Choosing a contraceptive requires consideration of the risk of pregnancy; the available contraception options; their risks, failure rates, and benefits; and the preferences of the woman. This review focuses on contraceptive selection in women with CHD.

show abstract

Section: Combined Hormonal Contraceptivesmentioning

confidence: 99%

Choosing the best contraceptive method for the adult with congenital heart disease

Silversides

Sermer²,

Siu³

2009

Curr Cardiol Rep

View full text Add to dashboard Cite

show abstract

“…Because users of third‐generation oral contraceptives were significantly younger than second‐generation oral contraceptive users and younger users are more likely to develop venous thrombosis, 16,18,22 imprecise matching of age could have created the association between third‐generation oral contraceptive users and venous thromboembolism. Indeed, when Farmer et al performed a nested case‐control study and matched subjects by exact age, there was no significant difference in risk of venous thromboembolism between users of third‐ and second‐generation oral contraceptives (OR 1.34; 95% CI 0.74, 2.39) 23 ; however, the study by Farmer et al has been criticized because the diagnosis of venous thromboembolism in the cases was not objectively confirmed, leading to misclassification bias 26,27 . When the data from the WHO and Jick et al studies were reanalyzed using only cases and controls that were within 1 and 2 years, respectively, of each other's age, the increased risk of venous thromboembolism in users of third‐generation, compared with second‐generation, oral contraceptives persisted (OR 2.3; 95% CI 1.0, 5.5; and 2.2; 95% CI 1.3, 3.6, respectively) 26,27 .…”

Section: Venous Thromboembolismmentioning

confidence: 99%

Benefits and risks of third-generation oral contraceptives

LeBlanc¹,

Laws

1999

J Gen Intern Med

View full text Add to dashboard Cite

OBJECTIVE:To evaluate the risks and benefits of thirdgeneration oral contraceptives. DATA SOURCES: When used consistently, oral contraceptives are a highly effective means of birth control. However, some women discontinue their use because of bothersome side effects such as acne, hirsutism, and weight gain. Oral contraceptives adversely affect thrombolysis, carbohydrate metabolism, and lipid profiles, and this may be why they have been associated with an increased risk of myocardial infarction and stroke in case-control and cohort studies. 1-4 Because these minor and major side effects have been correlated with the androgenicity of the progestin, third-generation oral contraceptives were created to decrease the amount of androgenic activity. They contain only low doses of estrogen ( Յ 35 g of ethinyl estradiol) combined with either desogestrel, norgestimate, or gestodene (gestodene is not FDA-approved for use in the United States), which are progestins with low androgenic activity (Table 1). Although they appear to be as effective as previous oral contraceptives and have a decreased incidence of side effects, they have been associated with an increased rate of venous thromboembolism. This prompted some regulatory agencies and professional groups to recommend restricting the prescribing of thirdgeneration oral contraceptives, but others contend that the data are not convincing enough to limit their use. This article will review the risks and benefits of third-generation oral contraceptives. METHODSA MEDLINE search of articles published from 1985 to 1998 was performed. The terms oral contraceptives , desogestrel , third-generation oral contraceptives , gestodene , and norgestimate were combined with the terms thromboembolism , myocardial infarction , cerebrovascular disorders , adverse effects , and stroke . English language articles containing original data on the association between thirdgeneration oral contraceptives and thromboembolism or cardiovascular disease were reviewed by both authors. Studies on the side effects of third-generation oral contraceptives and editorials on the controversy surrounding the relation between third-generation oral contraceptives and venous thrombosis, myocardial infarction, and stroke were also evaluated. In addition, references of articles were reviewed for other studies not identified by the MED-LINE search. All published studies containing original data on the relation between third-generation oral contraceptives and thromboembolic disease, myocardial infarction, or stroke are included in this review.

show abstract

“…In 1997 we published a study based on the MediPlus database that showed no difference in the risk associated with combined oral contraceptives containing either levonorgestrel, desogestrel or gestodene [6]. It has been pointed out that in this study the diagnosis of VTE in the selected cases was not validated with hospital discharge records or notes held by the general practitioners [7–9]. Furthermore the study included cases with a diagnosis of venous thromboembolism and evidence of anticoagulant treatment, but did not require a computer record of hospital admission.…”

Section: Introductionmentioning

confidence: 99%

Validation of the diagnosis of venous thromboembolism in general practice database studies

Lawrenson

Todd

Leydon³

et al. 2000

Brit J Clinical Pharma

163

175

View full text Add to dashboard Cite

Aims The study was conducted to determine whether the method for selecting cases of venous thromboembolism (VTE) from general practice databases signi®cantly affected the ®ndings of an epidemiological study. Methods Cases of VTE were identi®ed from the UK General Practice Research Database (GPRD) by searching for codes for deep vein thrombosis (DVT) and pulmonary embolism (PE). These had to be supported by evidence of anticoagulation and be exposed to a combined oral contraceptive (COC) at the time of the event. Additional information about the event was sought from general practitioners who were requested to complete a questionnaire and to supply anonymised copies of hospital letters and discharge summaries. Results Of the 285 cases identi®ed from the GPRD, additional information was available for 177 VTE events. This information showed that 84% of those events were supported by hospital investigations or a death certi®cate. Using only veri®ed cases, rather than all GPRD identi®ed events, did not alter the results of the epidemiological study.Conclusions The GPRD provides information of suf®ciently high quality to allow valid epidemiological research of VTE events. Excluding cases without a database record of hospital admission would lead to valid events being overlooked, and an under-estimate of the disease incidence.

show abstract

Third-generation oral contraceptives and venous thrombosis

Cited by 22 publications

References 5 publications

Choosing the best contraceptive method for the adult with congenital heart disease

Choosing the best contraceptive method for the adult with congenital heart disease

Benefits and risks of third-generation oral contraceptives

Validation of the diagnosis of venous thromboembolism in general practice database studies

Contact Info

Product

Resources

About