Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis.
Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis.
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DOI：
10.1136/bmj.f5298
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发表时间：
2013-09-12
期刊：
影响因子：
--
通讯作者：
Dekkers OM
中科院分区：
文献类型：
--
作者：
Stegeman BH;de Bastos M;Rosendaal FR;van Hylckama Vlieg A;Helmerhorst FM;Stijnen T;Dekkers OM
目的对使用不同复方口服避孕药的妇女静脉血栓形成的风险进行全面综述。设计系统综述和网络荟萃分析。数据来源PubMed、Embase、Web of Science、科克伦、护理和相关健康文献累积索引、Academic Search Premier和ScienceDirect，截至2013年4月22日。回顾方法：观察性研究，评估联合口服避孕药对健康女性静脉血栓形成的影响。关注的主要结局是静脉血栓形成的致死性或非致死性首起事件，主要关注深静脉血栓形成或肺栓塞。总共至少发生10起事件的出版物才有资格。使用扩展的频率主义随机效应模型进行网络荟萃分析，用于混合多治疗比较。报告了未校正的相对风险和95%置信区间。对粗略数字的要求不允许调整潜在的混杂变量。结果通过检索策略共检索到3110篇文献，纳入了26项研究的25篇文献。两个纳入队列的非使用者静脉血栓形成的发生率分别为1.9和3.7/10000女性年，与先前报告的1-6/10000女性年的发生率一致。与不使用相比，使用复方口服避孕药增加了静脉血栓形成的风险（相对风险3.5，95%置信区间2.9至4.3）。含30-35 µg炔雌醇和孕二烯酮、去氧孕烯、醋酸环丙孕酮或屈螺酮的复方口服避孕药的静脉血栓形成相对风险相似，比含左炔诺孕酮的复方口服避孕药高约50-80%。观察到炔雌醇对孕二烯酮、去氧孕烯和左炔诺孕酮的剂量相关效应，较高剂量与较高血栓形成风险相关。结论：本分析中研究的所有复方口服避孕药均与静脉血栓形成风险增加相关。效果大小取决于所用孕激素和炔雌醇的剂量。
Objective To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives. Design Systematic review and network meta-analysis. Data sources PubMed, Embase, Web of Science, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, and ScienceDirect up to 22 April 2013. Review methods Observational studies that assessed the effect of combined oral contraceptives on venous thrombosis in healthy women. The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported. The requirement for crude numbers did not allow adjustment for potential confounding variables. Results 3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 1.9 and 3.7 per 10 000 woman years, in line with previously reported incidences of 1-6 per 10 000 woman years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 µg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene, desogestrel, and levonorgestrel, with higher doses being associated with higher thrombosis risk. Conclusion All combined oral contraceptives investigated in this analysis were associated with an increased risk of venous thrombosis. The effect size depended both on the progestogen used and the dose of ethinylestradiol.
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