Takaisin Tulosta

Oral contraceptives in patients who have experienced one venous thrombosis

Evidence summaries
Editors
21.2.2015

Level of evidence: C

The risk of a recurrent venous thromboembolism after one thrombotic event in users of oral contraceptives may be increased compared with nonusers.

A systematic review «Koster T, Small RA, Rosendaal FR, Helmerhorst FM. ...»1 including 8 case-control studies, 6 follow-up studies and one randomised trial was abstracted in DARE. The unweighted summary relative risk for a new venous thrombosis or thromboembolism (VTE) was 2.9 (95% CI 0.5 to 17)(G test for homogeneity p<0.001). For case-control studies the RR was 4.2 (95% CI 1.3 to 14), and for follow-up studies it was 2.1 (95% CI 0.3 to 16). For the one RCT it was 1.1 (95% CI 0.4 to 2.9). The funnel plot did not reveal evidence of publication bias.

In a prospective cohort study «Le Moigne E, Delluc A, Tromeur C et al. Risk of re...»2 in France the risk of a recurrent VTE in women after a first oestrogen contraception associated VTE episode was assessed. Women under 50 years were consecutively enrolled between 1992 and 2011. Of the 241 women who were followed-up after stopping anticoagulation, there were 180 COC-users and 61 non-users. Median duration of follow-up off-anticoagulants was 66 months (interquartile range: 33-103). There were 14 recurrences in COC-users and 5 cases in non-users. No significant association was found between exposure to COC and the incidence of recurrent VTE after adjustment for age or after restricting the analysis to major unprovoked VTE: incidence rate of recurrence 17.9/1,000/year (95% CI: 9.6-33.2) in women with COC as compared with 17.6/1,000/year (95% CI: 6.6-47) with an incidence ratio of 0.7 (95% CI: 0.2-2.4, p=0.59).

References

  1. Koster T, Small RA, Rosendaal FR, Helmerhorst FM. Oral contraceptives and venous thromboembolism: a quantitative discussion of the uncertainties. J Intern Med 1995 Jul;238(1):31-7. «PMID: 7608644»PubMed «DARE-11995001917»DARE
  2. Le Moigne E, Delluc A, Tromeur C et al. Risk of recurrent venous thromboembolism among young women after a first event while exposed to combined oral contraception versus not exposed to: a cohort study. Thromb Res 2013;132(1):51-5. «PMID: 23786893»PubMed