Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis
Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis
复制标题
DOI：
10.1503/cmaj.120677
复制
发表时间：
2013-02-05
影响因子：
14.6
通讯作者：
Delaney, Joseph A. C.
中科院分区：
文献类型：
--
作者：
Bird, Steven T.;Hartzema, Abraham G.;Delaney, Joseph A. C.
背景：服用口服避孕药的女性发生静脉血栓栓塞的风险增加。然而，是否有一个额外的风险与多囊卵巢综合征（PCOS）的妇女是unknown.Methods：我们开发了一个基于人群的队列IMS LifeLink健康计划索赔数据库，其中包括在美国的管理式医疗机构。年龄在1846岁的妇女服用复方口服避孕药，并声称PCOS（n = 43 506）匹配，根据倾向评分，控制妇女（n = 43 506）服用口服避孕药。使用管理编码和抗凝治疗定义静脉血栓栓塞。我们使用考克斯比例风险模型来评估静脉血栓栓塞的相对危险度（RR）的联合口服避孕药的使用者与非PCOS。结果：静脉血栓栓塞的发病率在PCOS女性为23.7/10 000人年，而匹配的对照组为10.9/10 000人年。与其他避孕药使用者相比，服用复方口服避孕药的PCOS女性发生静脉血栓栓塞的RR为2.14（95%置信区间[CI] 1.41-3.24）。未服用口服避孕药的PCOS女性静脉血栓栓塞的发生率为6.3/10000人-年;匹配对照组的发生率为4.1/10000人-年。未服用口服避孕药的PCOS女性静脉血栓栓塞的RR为1.55（95%CI 1.10-2.19）。解释：我们发现服用复方口服避孕药的PCOS女性静脉血栓栓塞的风险增加2倍，未服用口服避孕药的PCOS女性静脉血栓栓塞的风险增加1.5倍。医生在给PCOS妇女开避孕药时应考虑静脉血栓栓塞的风险增加。
Background: There is an increased risk of venous thromboembolism among women taking oral contraceptives. However, whether there is an additional risk among women with polycystic ovary syndrome (PCOS) is unknown.Methods: We developed a population-based cohort from the IMS LifeLink Health Plan Claims Database, which includes managed care organizations in the United States. Women aged 1846 years taking combined oral contraceptives and who had a claim for PCOS (n = 43 506) were matched, based on a propensity score, to control women (n = 43 506) taking oral contraceptives. Venous thromboembolism was defined using administrative coding and use of anticoagulation. We used Cox proportional hazards models to assess the relative risk (RR) of venous thromboembolism among users of combined oral contraceptives with and without PCOS.Results: The incidence of venous thromboembolism among women with PCOS was 23.7/10 000 person-years, while that for matched controls was 10.9/10 000 person-years. Women with PCOS taking combined oral contraceptives had an RR for venous thromboembolism of 2.14 (95% confidence interval [CI] 1.41-3.24) compared with other contraceptive users. The incidence of venous thromboembolism was 6.3/10 000 person-years among women with PCOS not taking oral contraceptives; the incidence was 4.1/10 000 person-years among matched controls. The RR of venous thromboembolism among women with PCOS not taking oral contraceptives was 1.55 (95% CI 1.10-2.19).Interpretation: We found a 2-fold increased risk of venous thromboembolism among women with PCOS who were taking combined oral contraceptives and a 1.5-fold increased risk among women with PCOS not taking oral contraceptives. Physicians should consider the increased risk of venous thromboembolism when prescribing contraceptive therapy to women with PCOS.