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Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10.
BMJ. 2012 May 10; 344:e2990.BMJ

Abstract

OBJECTIVE

To assess the risk of venous thrombosis in current users of non-oral hormonal contraception.

DESIGN

Historical national registry based cohort study.

SETTING

Four national registries in Denmark.

PARTICIPANTS

All Danish non-pregnant women aged 15-49 (n=1,626,158), free of previous thrombotic disease or cancer, were followed from 2001 to 2010.

MAIN OUTCOME MEASURES

Incidence rate of venous thrombosis in users of transdermal, vaginal, intrauterine, or subcutaneous hormonal contraception, relative risk of venous thrombosis compared with non-users, and rate ratios of venous thrombosis in current users of non-oral products compared with the standard reference oral contraceptive with levonorgestrel and 30-40 µg oestrogen. Diagnoses were confirmed by at least four weeks of anticoagulation therapy after the diagnosis.

RESULTS

Within 9,429,128 woman years of observation, 5287 first ever venous thrombosis events were recorded, of which 3434 were confirmed. In non-users of hormonal contraception the incidence rate of confirmed events was 2.1 per 10,000 woman years. Compared with non-users of hormonal contraception, and after adjustment for age, calendar year, and education, the relative risk of confirmed venous thrombosis in users of transdermal combined contraceptive patches was 7.9 (95% confidence interval 3.5 to 17.7) and of the vaginal ring was 6.5 (4.7 to 8.9). The corresponding incidences per 10,000 exposure years were 9.7 and 7.8 events. The relative risk was increased in women who used subcutaneous implants (1.4, 0.6 to 3.4) but not in those who used the levonorgestrel intrauterine system (0.6, 0.4 to 0.8). Compared with users of combined oral contraceptives containing levonorgestrel, the adjusted relative risk of venous thrombosis in users of transdermal patches was 2.3 (1.0 to 5.2) and of the vaginal ring was 1.9 (1.3 to 2.7).

CONCLUSION

Women who use transdermal patches or vaginal rings for contraception have a 7.9 and 6.5 times increased risk of confirmed venous thrombosis compared with non-users of hormonal contraception of the same age, corresponding to 9.7 and 7.8 events per 10,000 exposure years. The risk was slightly increased in women using subcutaneous implants but not in those using the levonorgestrel intrauterine system.

Authors+Show Affiliations

Gynaecological Clinic, Copehagen Ø, Juliane Marie Centre, Rigshospitalet, University of Copenhagen, Denmark. lidegaard@rh.regionh.dkNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22577198

Citation

Lidegaard, Ojvind, et al. "Venous Thrombosis in Users of Non-oral Hormonal Contraception: Follow-up Study, Denmark 2001-10." BMJ (Clinical Research Ed.), vol. 344, 2012, pp. e2990.
Lidegaard O, Nielsen LH, Skovlund CW, et al. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10. BMJ. 2012;344:e2990.
Lidegaard, O., Nielsen, L. H., Skovlund, C. W., & Løkkegaard, E. (2012). Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10. BMJ (Clinical Research Ed.), 344, e2990. https://doi.org/10.1136/bmj.e2990
Lidegaard O, et al. Venous Thrombosis in Users of Non-oral Hormonal Contraception: Follow-up Study, Denmark 2001-10. BMJ. 2012 May 10;344:e2990. PubMed PMID: 22577198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10. AU - Lidegaard,Ojvind, AU - Nielsen,Lars Hougaard, AU - Skovlund,Charlotte Wessel, AU - Løkkegaard,Ellen, Y1 - 2012/05/10/ PY - 2012/5/12/entrez PY - 2012/5/12/pubmed PY - 2012/7/4/medline SP - e2990 EP - e2990 JF - BMJ (Clinical research ed.) JO - BMJ VL - 344 N2 - OBJECTIVE: To assess the risk of venous thrombosis in current users of non-oral hormonal contraception. DESIGN: Historical national registry based cohort study. SETTING: Four national registries in Denmark. PARTICIPANTS: All Danish non-pregnant women aged 15-49 (n=1,626,158), free of previous thrombotic disease or cancer, were followed from 2001 to 2010. MAIN OUTCOME MEASURES: Incidence rate of venous thrombosis in users of transdermal, vaginal, intrauterine, or subcutaneous hormonal contraception, relative risk of venous thrombosis compared with non-users, and rate ratios of venous thrombosis in current users of non-oral products compared with the standard reference oral contraceptive with levonorgestrel and 30-40 µg oestrogen. Diagnoses were confirmed by at least four weeks of anticoagulation therapy after the diagnosis. RESULTS: Within 9,429,128 woman years of observation, 5287 first ever venous thrombosis events were recorded, of which 3434 were confirmed. In non-users of hormonal contraception the incidence rate of confirmed events was 2.1 per 10,000 woman years. Compared with non-users of hormonal contraception, and after adjustment for age, calendar year, and education, the relative risk of confirmed venous thrombosis in users of transdermal combined contraceptive patches was 7.9 (95% confidence interval 3.5 to 17.7) and of the vaginal ring was 6.5 (4.7 to 8.9). The corresponding incidences per 10,000 exposure years were 9.7 and 7.8 events. The relative risk was increased in women who used subcutaneous implants (1.4, 0.6 to 3.4) but not in those who used the levonorgestrel intrauterine system (0.6, 0.4 to 0.8). Compared with users of combined oral contraceptives containing levonorgestrel, the adjusted relative risk of venous thrombosis in users of transdermal patches was 2.3 (1.0 to 5.2) and of the vaginal ring was 1.9 (1.3 to 2.7). CONCLUSION: Women who use transdermal patches or vaginal rings for contraception have a 7.9 and 6.5 times increased risk of confirmed venous thrombosis compared with non-users of hormonal contraception of the same age, corresponding to 9.7 and 7.8 events per 10,000 exposure years. The risk was slightly increased in women using subcutaneous implants but not in those using the levonorgestrel intrauterine system. SN - 1756-1833 UR - https://www.unboundmedicine.com/medline/citation/22577198/Venous_thrombosis_in_users_of_non_oral_hormonal_contraception:_follow_up_study_Denmark_2001_10_ L2 - http://www.bmj.com/cgi/pmidlookup?view=long&pmid=22577198 DB - PRIME DP - Unbound Medicine ER -