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Combined hormonal contraception raises the risk for venous thromboembolism fivefold overall, with certain formulations increasing that risk even further and with thrombophilic genotypes raising it further still, according to a report published online Aug. 5 in Obstetrics & Gynecology.
To assess the association between various types of hormonal contraception and venous thromboembolism (VTE) risk, Swedish investigators performed a nationwide case-control study involving 948 women aged 18-54 years who were treated for deep vein thrombosis of the leg or pelvis, pulmonary embolism, or both conditions during a 6-year period and 902 healthy control subjects from the general population. All the women provided a blood sample for genetic analysis and provided detailed information regarding their contraceptive use, body mass index (BMI), smoking status, and recent history of immobilization, said Dr. Annica Bergendal of the Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, and her associates.
A total of 32.8% of the case group reported current use of combined hormonal contraception, compared with only 11.9% of the control group. Overall, current use of combined hormonal contraception was associated with a fivefold increased risk of VTE, with an adjusted OR of 5.3. "Combinations with the progestogen desogestrel yielded the highest risk estimate (adjusted OR, 11.4), followed by drospirenone (adjusted OR, 8.4). The adjusted OR could not be calculated for lynestrenol because there were no exposed women in the control group," the investigators wrote (Obstet. Gynecol. 2014;124:600-9).
In contrast, progestogen-only contraception did not increase the risk of VTE, except at the highest dose level.
Women who used combination contraception and were carriers of factor V Leiden or of the prothrombin gene mutation were at extremely high risk for VTE, nearly 20-fold for either, compared with nonusers and noncarriers. Women who used combination contraception and were carriers of factor XIII had a much lower, but still elevated, risk for VTE (OR, 2.8).
All of these differences in risk appeared to be independent of BMI, smoking status, and recent history of immobilization, Dr. Bergendal and her associates added.
This study was supported by unrestricted grants from Janssen-Cilag, Novartis, Organon, Schering, Wyeth, AFA Insurance, and the Medical Products Agency. Dr. Bergendal and her associates reported no relevant financial conflicts.
How important is this issue to vascular surgeons? In some ways this depends on how far-reaching you see your role as a vascular surgeon being. Certainly it is relevant primarily to vascular surgeons treating young female patients with venous disease, including varicose veins, central venous stenosis (May-Thurner or Pelvic Congestion Syndrome), and, of course, patients with acute or chronic deep vein thrombosis.
 |
| Dr. Cynthia K. Shortell |
For patients undergoing venous ablations, iliac stents or treatment for low-flow vascular malformations, we must be aware so we can consider treating prophylactically around the time of these procedures. For DVT patients, there is great variation among medical practitioners with regard to the level of awareness around the subtleties of risk factors for DVT and management of DVT. For example, an Ob.Gyn. or hematologist might be very aware of the relative risk of DVT with different forms of oral contraception, while many primary care or emergency medicine physicians might not be so well versed. For this reason, it is incumbent on the vascular surgeon, as the specialist whose care encompasses the entirety of the disease spectrum, to be aware of these and other findings relevant to the comprehensive care of our patients, as it may often be up to us to recognize these issues.
Dr. Cynthia K. Shortell is professor and chief, Division of Vascular Surgery, Duke University Medical Center and an associate medical editor of Vascular Specialist.
How important is this issue to vascular surgeons? In some ways this depends on how far-reaching you see your role as a vascular surgeon being. Certainly it is relevant primarily to vascular surgeons treating young female patients with venous disease, including varicose veins, central venous stenosis (May-Thurner or Pelvic Congestion Syndrome), and, of course, patients with acute or chronic deep vein thrombosis.
|
| Dr. Cynthia K. Shortell |
For patients undergoing venous ablations, iliac stents or treatment for low-flow vascular malformations, we must be aware so we can consider treating prophylactically around the time of these procedures. For DVT patients, there is great variation among medical practitioners with regard to the level of awareness around the subtleties of risk factors for DVT and management of DVT. For example, an Ob.Gyn. or hematologist might be very aware of the relative risk of DVT with different forms of oral contraception, while many primary care or emergency medicine physicians might not be so well versed. For this reason, it is incumbent on the vascular surgeon, as the specialist whose care encompasses the entirety of the disease spectrum, to be aware of these and other findings relevant to the comprehensive care of our patients, as it may often be up to us to recognize these issues.
Dr. Cynthia K. Shortell is professor and chief, Division of Vascular Surgery, Duke University Medical Center and an associate medical editor of Vascular Specialist.
How important is this issue to vascular surgeons? In some ways this depends on how far-reaching you see your role as a vascular surgeon being. Certainly it is relevant primarily to vascular surgeons treating young female patients with venous disease, including varicose veins, central venous stenosis (May-Thurner or Pelvic Congestion Syndrome), and, of course, patients with acute or chronic deep vein thrombosis.
|
| Dr. Cynthia K. Shortell |
For patients undergoing venous ablations, iliac stents or treatment for low-flow vascular malformations, we must be aware so we can consider treating prophylactically around the time of these procedures. For DVT patients, there is great variation among medical practitioners with regard to the level of awareness around the subtleties of risk factors for DVT and management of DVT. For example, an Ob.Gyn. or hematologist might be very aware of the relative risk of DVT with different forms of oral contraception, while many primary care or emergency medicine physicians might not be so well versed. For this reason, it is incumbent on the vascular surgeon, as the specialist whose care encompasses the entirety of the disease spectrum, to be aware of these and other findings relevant to the comprehensive care of our patients, as it may often be up to us to recognize these issues.
Dr. Cynthia K. Shortell is professor and chief, Division of Vascular Surgery, Duke University Medical Center and an associate medical editor of Vascular Specialist.
Combined hormonal contraception raises the risk for venous thromboembolism fivefold overall, with certain formulations increasing that risk even further and with thrombophilic genotypes raising it further still, according to a report published online Aug. 5 in Obstetrics & Gynecology.
To assess the association between various types of hormonal contraception and venous thromboembolism (VTE) risk, Swedish investigators performed a nationwide case-control study involving 948 women aged 18-54 years who were treated for deep vein thrombosis of the leg or pelvis, pulmonary embolism, or both conditions during a 6-year period and 902 healthy control subjects from the general population. All the women provided a blood sample for genetic analysis and provided detailed information regarding their contraceptive use, body mass index (BMI), smoking status, and recent history of immobilization, said Dr. Annica Bergendal of the Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, and her associates.
A total of 32.8% of the case group reported current use of combined hormonal contraception, compared with only 11.9% of the control group. Overall, current use of combined hormonal contraception was associated with a fivefold increased risk of VTE, with an adjusted OR of 5.3. "Combinations with the progestogen desogestrel yielded the highest risk estimate (adjusted OR, 11.4), followed by drospirenone (adjusted OR, 8.4). The adjusted OR could not be calculated for lynestrenol because there were no exposed women in the control group," the investigators wrote (Obstet. Gynecol. 2014;124:600-9).
In contrast, progestogen-only contraception did not increase the risk of VTE, except at the highest dose level.
Women who used combination contraception and were carriers of factor V Leiden or of the prothrombin gene mutation were at extremely high risk for VTE, nearly 20-fold for either, compared with nonusers and noncarriers. Women who used combination contraception and were carriers of factor XIII had a much lower, but still elevated, risk for VTE (OR, 2.8).
All of these differences in risk appeared to be independent of BMI, smoking status, and recent history of immobilization, Dr. Bergendal and her associates added.
This study was supported by unrestricted grants from Janssen-Cilag, Novartis, Organon, Schering, Wyeth, AFA Insurance, and the Medical Products Agency. Dr. Bergendal and her associates reported no relevant financial conflicts.
Combined hormonal contraception raises the risk for venous thromboembolism fivefold overall, with certain formulations increasing that risk even further and with thrombophilic genotypes raising it further still, according to a report published online Aug. 5 in Obstetrics & Gynecology.
To assess the association between various types of hormonal contraception and venous thromboembolism (VTE) risk, Swedish investigators performed a nationwide case-control study involving 948 women aged 18-54 years who were treated for deep vein thrombosis of the leg or pelvis, pulmonary embolism, or both conditions during a 6-year period and 902 healthy control subjects from the general population. All the women provided a blood sample for genetic analysis and provided detailed information regarding their contraceptive use, body mass index (BMI), smoking status, and recent history of immobilization, said Dr. Annica Bergendal of the Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, and her associates.
A total of 32.8% of the case group reported current use of combined hormonal contraception, compared with only 11.9% of the control group. Overall, current use of combined hormonal contraception was associated with a fivefold increased risk of VTE, with an adjusted OR of 5.3. "Combinations with the progestogen desogestrel yielded the highest risk estimate (adjusted OR, 11.4), followed by drospirenone (adjusted OR, 8.4). The adjusted OR could not be calculated for lynestrenol because there were no exposed women in the control group," the investigators wrote (Obstet. Gynecol. 2014;124:600-9).
In contrast, progestogen-only contraception did not increase the risk of VTE, except at the highest dose level.
Women who used combination contraception and were carriers of factor V Leiden or of the prothrombin gene mutation were at extremely high risk for VTE, nearly 20-fold for either, compared with nonusers and noncarriers. Women who used combination contraception and were carriers of factor XIII had a much lower, but still elevated, risk for VTE (OR, 2.8).
All of these differences in risk appeared to be independent of BMI, smoking status, and recent history of immobilization, Dr. Bergendal and her associates added.
This study was supported by unrestricted grants from Janssen-Cilag, Novartis, Organon, Schering, Wyeth, AFA Insurance, and the Medical Products Agency. Dr. Bergendal and her associates reported no relevant financial conflicts.
FROM OBSTETRICS & GYNECOLOGY
Key clinical point: Combined hormonal contraception increases the risk of VTE, especially in women with certain thrombophilic genotypes.
Major finding: Current use of combined hormonal contraception was associated with a fivefold increased risk of VTE (adjusted OR, 5.3); combinations with the progestogen desogestrel yielded the highest risk estimate (adjusted OR, 11.4), followed by those containing drospirenone (adjusted OR, 8.4).
Data source: A nationwide Swedish case-control study involving 948 women aged 18-54 years treated for deep vein thrombosis or pulmonary embolism over the course of 6 years and 902 control subjects.
Disclosures: This study was supported by unrestricted grants from Janssen-Cilag, Novartis, Organon, Schering, Wyeth, AFA Insurance, and the Medical Products Agency. Dr. Bergendal and her associates reported no financial conflicts.
