Higher risk of venous thrombosis associated with drospirenone-containing oral contraceptives: a population-based cohort study
Higher risk of venous thrombosis associated with drospirenone-containing oral contraceptives: a population-based cohort study
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DOI：
10.1503/cmaj.110463
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发表时间：
2011-12-13
影响因子：
14.6
通讯作者：
Rennert, Gad
中科院分区：
文献类型：
--
作者：
Gronich, Naomi;Lavi, Idit;Rennert, Gad
背景：联合口服避孕药是一种常见的避孕方法，但它们存在静脉和动脉血栓形成的风险。我们评估了使用屈螺酮是否与第三代联合口服避孕药的血栓风险增加有关。方法：使用以色列最大的医疗保健提供者的计算机记录，我们确定了在2002年1月1日至2008年12月31日期间分发联合口服避孕药的所有12至50岁的女性。直到2009年，我们一直在跟踪这一队列。我们使用泊松回归模型来估计静脉血栓事件(特别是深静脉血栓和肺栓塞)和动脉血栓事件(特别是短暂性脑缺血发作和脑血管意外)的危险因素的粗率比和调整比。结果：在819749妇女年的随访中，在431 223次使用中，我们确定了1017例(0.24%)静脉和动脉血栓事件(每1万妇女年6.33次静脉事件和6.10次动脉事件)。在多变量模型中，与第三代联合口服避孕药(比率比[RR]1.43，95%可信区间[CI]1.15-1.78)和第二代联合口服避孕药(相对危险度1.65，95%可信区间1.02-2.65)相比，使用屈螺环酮增加了静脉血栓事件的风险。解释：与第二代和第三代口服避孕药相比，使用含有屈螺酮的口服避孕药与深静脉血栓形成和肺栓塞的风险增加有关，但与短暂性脑缺血发作或脑血管发作无关。
Background: Combined oral contraceptives are a common method of contraception, but they carry a risk of venous and arterial thrombosis. We assessed whether use of drospirenone was associated with an increase in thrombotic risk relative to third-generation combined oral contraceptives.Methods: Using computerized records of the largest health care provider in Israel, we identified all women aged 12 to 50 years for whom combined oral contraceptives had been dispensed between Jan. 1, 2002, and Dec. 31, 2008. We followed the cohort until 2009. We used Poisson regression models to estimate the crude and adjusted rate ratios for risk factors for venous thrombotic events (specifically deep vein thrombosis and pulmonary embolism) and arterial thromboic events (specifically transient ischemic attack and cerebrovascular accident). We performed multivariable analyses to compare types of contraceptives, with adjustment for the various risk factors.Results: We identified a total of 1017 (0.24%) venous and arterial thrombotic events among 431 223 use episodes during 819 749 woman-years of follow-up (6.33 venous events and 6.10 arterial events per 10 000 woman-years). In a multivariable model, use of drospirenone carried an increased risk of venous thrombotic events, relative to both third-generation combined oral contraceptives (rate ratio [RR] 1.43, 95% confidence interval [CI] 1.15-1.78) and second-generation combined oral contraceptives (RR 1.65, 95% CI 1.02-2.65). There was no increase in the risk of arterial thrombosis with drospirenone.Interpretation: Use of drospirenone-containing oral contraceptives was associated with an increased risk of deep vein thrombosis and pulmonary embolism, but not transient ischemic attack or cerebrovascular attack, relative to second- and third-generation combined oral contraceptives.