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Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9.
BMJ. 2011 Oct 25; 343:d6423.BMJ

Abstract

OBJECTIVE

To assess the risk of venous thromboembolism from use of combined oral contraceptives according to progestogen type and oestrogen dose.

DESIGN

National historical registry based cohort study.

SETTING

Four registries in Denmark.

PARTICIPANTS

Non-pregnant Danish women aged 15-49 with no history of thrombotic disease and followed from January 2001 to December 2009.

MAIN OUTCOME MEASURES

Relative and absolute risks of first time venous thromboembolism.

RESULTS

Within 8,010,290 women years of observation, 4307 first ever venous thromboembolic events were recorded and 4246 included, among which 2847 (67%) events were confirmed as certain. Compared with non-users of hormonal contraception, the relative risk of confirmed venous thromboembolism in users of oral contraceptives containing 30-40 µg ethinylestradiol with levonorgestrel was 2.9 (95% confidence interval 2.2 to 3.8), with desogestrel was 6.6 (5.6 to 7.8), with gestodene was 6.2 (5.6 to 7.0), and with drospirenone was 6.4 (5.4 to 7.5). With users of oral contraceptives with levonorgestrel as reference and after adjusting for length of use, the rate ratio of confirmed venous thromboembolism for users of oral contraceptives with desogestrel was 2.2 (1.7 to 3.0), with gestodene was 2.1 (1.6 to 2.8), and with drospirenone was 2.1 (1.6 to 2.8). The risk of confirmed venous thromboembolism was not increased with use of progestogen only pills or hormone releasing intrauterine devices. If oral contraceptives with desogestrel, gestodene, or drospirenone are anticipated to increase the risk of venous thromboembolism sixfold and those with levonorgestrel threefold, and the absolute risk of venous thromboembolism in current users of the former group is on average 10 per 10,000 women years, then 2000 women would need to shift from using oral contraceptives with desogestrel, gestodene, or drospirenone to those with levonorgestrel to prevent one event of venous thromboembolism in one year.

CONCLUSION

After adjustment for length of use, users of oral contraceptives with desogestrel, gestodene, or drospirenone were at least at twice the risk of venous thromboembolism compared with users of oral contraceptives with levonorgestrel.

Authors+Show Affiliations

Gynaecological Clinic 4232, Rigshospitalet, University of Copenhagen, Denmark. Lidegaard@rh.regionh.dkNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22027398

Citation

Lidegaard, Øjvind, et al. "Risk of Venous Thromboembolism From Use of Oral Contraceptives Containing Different Progestogens and Oestrogen Doses: Danish Cohort Study, 2001-9." BMJ (Clinical Research Ed.), vol. 343, 2011, pp. d6423.
Lidegaard Ø, Nielsen LH, Skovlund CW, et al. Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9. BMJ. 2011;343:d6423.
Lidegaard, Ø., Nielsen, L. H., Skovlund, C. W., Skjeldestad, F. E., & Løkkegaard, E. (2011). Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9. BMJ (Clinical Research Ed.), 343, d6423. https://doi.org/10.1136/bmj.d6423
Lidegaard Ø, et al. Risk of Venous Thromboembolism From Use of Oral Contraceptives Containing Different Progestogens and Oestrogen Doses: Danish Cohort Study, 2001-9. BMJ. 2011 Oct 25;343:d6423. PubMed PMID: 22027398.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of venous thromboembolism from use of oral contraceptives containing different progestogens and oestrogen doses: Danish cohort study, 2001-9. AU - Lidegaard,Øjvind, AU - Nielsen,Lars Hougaard, AU - Skovlund,Charlotte Wessel, AU - Skjeldestad,Finn Egil, AU - Løkkegaard,Ellen, Y1 - 2011/10/25/ PY - 2011/10/27/entrez PY - 2011/10/27/pubmed PY - 2011/12/14/medline SP - d6423 EP - d6423 JF - BMJ (Clinical research ed.) JO - BMJ VL - 343 N2 - OBJECTIVE: To assess the risk of venous thromboembolism from use of combined oral contraceptives according to progestogen type and oestrogen dose. DESIGN: National historical registry based cohort study. SETTING: Four registries in Denmark. PARTICIPANTS: Non-pregnant Danish women aged 15-49 with no history of thrombotic disease and followed from January 2001 to December 2009. MAIN OUTCOME MEASURES: Relative and absolute risks of first time venous thromboembolism. RESULTS: Within 8,010,290 women years of observation, 4307 first ever venous thromboembolic events were recorded and 4246 included, among which 2847 (67%) events were confirmed as certain. Compared with non-users of hormonal contraception, the relative risk of confirmed venous thromboembolism in users of oral contraceptives containing 30-40 µg ethinylestradiol with levonorgestrel was 2.9 (95% confidence interval 2.2 to 3.8), with desogestrel was 6.6 (5.6 to 7.8), with gestodene was 6.2 (5.6 to 7.0), and with drospirenone was 6.4 (5.4 to 7.5). With users of oral contraceptives with levonorgestrel as reference and after adjusting for length of use, the rate ratio of confirmed venous thromboembolism for users of oral contraceptives with desogestrel was 2.2 (1.7 to 3.0), with gestodene was 2.1 (1.6 to 2.8), and with drospirenone was 2.1 (1.6 to 2.8). The risk of confirmed venous thromboembolism was not increased with use of progestogen only pills or hormone releasing intrauterine devices. If oral contraceptives with desogestrel, gestodene, or drospirenone are anticipated to increase the risk of venous thromboembolism sixfold and those with levonorgestrel threefold, and the absolute risk of venous thromboembolism in current users of the former group is on average 10 per 10,000 women years, then 2000 women would need to shift from using oral contraceptives with desogestrel, gestodene, or drospirenone to those with levonorgestrel to prevent one event of venous thromboembolism in one year. CONCLUSION: After adjustment for length of use, users of oral contraceptives with desogestrel, gestodene, or drospirenone were at least at twice the risk of venous thromboembolism compared with users of oral contraceptives with levonorgestrel. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/22027398/Risk_of_venous_thromboembolism_from_use_of_oral_contraceptives_containing_different_progestogens_and_oestrogen_doses:_Danish_cohort_study_2001_9_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=22027398 DB - PRIME DP - Unbound Medicine ER -