Comparison of thromboembolism outcomes in patients with sickle cell disease prescribed hormonal contraception.
Comparison of thromboembolism outcomes in patients with sickle cell disease prescribed hormonal contraception.
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DOI：
10.1182/bloodadvances.2023010204
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发表时间：
2023-10-24
期刊：
影响因子：
7.5
通讯作者：
O'Brien, Sarah H.
中科院分区：
文献类型：
--
作者：
Bala, Natasha S.;Stanek, Joseph R.;Vesely, Sara K.;Cronin, Robert M.;Creary, Susan E.;Roe, Andrea H.;Xu, Wendy;O'Brien, Sarah H.
公共保险的 SCD 患者最常用的避孕药是复方避孕药和长效醋酸甲羟孕酮。接受联合激素治疗的 SCD 患者与 POC 患者的 TE 率没有显着差异。镰状细胞病 (SCD) 患者存在血栓栓塞 (TE) 的风险，而使用激素避孕药会进一步增加该风险。本研究旨在评估激素避孕药的使用模式，并比较复方激素避孕药 (CHC) 和纯孕激素避孕药 (POC) 之间避孕相关 TE 的风险。医疗保险和医疗补助服务中心医疗补助分析提取数据库（2006-2018）中对年龄在 12 至 44 岁之间的 SCD 患者使用新的激素避孕药处方进行了长达 1 年的随访。我们确定了 7173 个新用户：44.6% 发起了 CHC，55.4% 发起了 POC。复方口服避孕药（OCP；36.5%）和纯孕激素长效醋酸甲羟孕酮（33.9%）是最常用的处方药。共有 1.8% 的避孕使用者在首次确定避孕处方后 1 年内新诊断出 TE。 CHC 和 POC 用户之间的 TE 事件发生率没有显着差异（每 1000 人年分别为 17.2 次和 24.7 次事件）。在接受 OCP 治疗的患者中，根据雌激素剂量或孕激素生成情况，TE 事件发生率没有差异。与 OCP 相比，透皮贴剂的 TE 风险增加 2.4 倍。尽管受到回顾性研究设计和行政索赔数据使用的限制，本研究发现 SCD 患者的 CHC 和 POC 新使用者之间的 TE 率没有显着差异。在开始激素避孕之前，应仔细评估每位 SCD 患者潜在的 TE 危险因素。
The most commonly prescribed contraceptives in publicly insured patients with SCD are combination pills and depot medroxyprogesterone acetate. No significant differences were found in TE rates in patients with SCD prescribed combined hormonal vs POCs. Patients with sickle cell disease (SCD) are at a risk of thromboembolism (TE), and use of hormonal contraception can further increase that risk. This study aims to assess patterns of hormonal contraceptive use and compare risk of contraception-related TE between combined hormonal contraceptives (CHCs) and progestin-only contraceptives (POCs). Patients with SCD aged between 12 and 44 years with a new prescription of a hormonal contraceptive in the Centers for Medicare and Medicaid Services Medicaid Analytic eXtract database (2006-2018) were followed up to 1 year. We identified 7173 new users: 44.6% initiated CHC and 55.4% initiated POC. Combined oral contraceptive pills (OCPs; 36.5%) and progestin-only depot medroxyprogesterone acetate (33.9%) were the most frequently prescribed agents. A total of 1.8% of contraception users had a new diagnosis of TE within 1 year of the first identified contraception prescription. There were no significant differences in TE event rates between CHC and POC users (17.2 and 24.7 events per 1000 person-years, respectively). In patients prescribed OCP, there were no differences in TE event rates based on estrogen dose or progestin generation. Transdermal patch had a 2.4-fold increased risk of TE as compared with that of OCP. Although limited by the retrospective study design and use of administrative claims data, this study found no significant differences in TE rates between new users of CHC and POC in patients with SCD. Careful evaluation of underlying TE risk factors should be considered for each patient with SCD before initiation of hormonal contraception.
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影响因子：
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作者：
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