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- Title
Drospirenone-containing combined oral contraceptives and the risk of arterial thrombosis: a population-based nested case-control study.
- Authors
Larivée, N; Suissa, S; Eberg, M; Joseph, L; Eisenberg, MJ; Abenhaim, HA; Filion, KB; Larivée, N; Eisenberg, M J; Abenhaim, H A; Filion, K B
- Abstract
<bold>Objective: </bold>To compare the rate of arterial thromboembolism (ATE) of drospirenone-containing COCs to that of levonorgestrel-containing COCs.<bold>Design: </bold>Population-based cohort study.<bold>Setting: </bold>United Kingdom's Clinical Practice Research Datalink (CPRD), which contains clinical records for >11 million patients.<bold>Population: </bold>Women aged 16-45 years prescribed a drospirenone- or levonorgestrel-containing COC between May 2002 and June 2012.<bold>Methods: </bold>We conducted nested case-control analyses using risk set sampling to randomly select up to 10 controls for each ATE case, matched on age, cohort entry year, CPRD registration year, COC user type (first-time ever, new, switcher, or prevalent users), duration of COC use, duration of progestin-only or implantable contraceptive use, pre-cohort entry duration of drospirenone and levonorgestrel use, and duration of follow up.<bold>Main Outcome Measures: </bold>We used conditional logistic regression to estimate hazard ratios and 95% confidence intervals (CIs), adjusted for high-dimensional propensity scores.<bold>Results: </bold>Our cohort included 339 743 women followed over a mean 4.4 years, during which 228 ATE cases occurred: 37 myocardial infarctions, 170 strokes, and 21 other ATEs; overall rate: 1.5 events per 10 000 person-years (PYs). After adjusting for potential confounders, the hazard ratio for ATE with current use of drospirenone-containing COCs versus current use of levonorgestrel-containing COCs was 0.89 (95% CI 0.35, 2.28), corresponding to a rate difference of -0.16 events per 10 000 PYs.<bold>Conclusions: </bold>The overall rate of ATE in this population is low regardless of which COC was taken. We found little evidence of a difference in the rate of ATE with drospirenone- versus levonorgestrel-containing COCs.<bold>Tweetable Abstract: </bold>Little evidence was found of a greater incidence of arterial thrombosis with drospirenone versus levonorgestrel contraceptives.
- Subjects
PHYSIOLOGICAL effects of oral contraceptives; THROMBOEMBOLISM risk factors; LEVONORGESTREL; CONTRACEPTIVE drugs; PROGESTATIONAL hormones; CONTRACEPTIVE drug implants; STEROID drugs; DRUG administration; ORAL contraceptives; STEROIDS; THROMBOEMBOLISM; VEINS; CASE-control method; THERAPEUTICS
- Publication
BJOG: An International Journal of Obstetrics & Gynaecology, 2017, Vol 124, Issue 11, p1672
- ISSN
1470-0328
- Publication type
journal article
- DOI
10.1111/1471-0528.14358