Despite 20 years of controversy, the definitive answer as to whether newer contraceptive pills further increase venous thromboembolism risk remains elusive
The 19th century German physician Rudolf Virchow described the mechanism of venous thromboembolism (VTE) in terms of interactions between haemodynamics, vein wall disruption and hypercoagulability. An understanding of this interplay is particularly important in a women’s health context since changes in the hormonal milieu, such as those seen in pregnancy and the use of exogenous oestrogen therapy, may act in concert to further increase VTE risk.
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- 1. Zöller B, Norlund L, Leksell H, et al. High prevalence of the FVR506Q mutation causing APC resistance in a region of southern Sweden with a high incidence of venous thrombosis. Thromb Res 1996; 83: 475-477.
- 2. Hankey GJ, Eikelboom JW, van Bockxmeer FM, et al. Inherited thrombophilia in ischemic stroke and its pathogenic subtypes. Stroke 2001; 32: 1793-1799.
- 3. Reid R, Leyland N, Wolfman W, et al. SOGC clinical practice guidelines: oral contraceptives and the risk of venous thromboembolism: an update: no. 252, December 2010. Int J Gynaecol Obstet 2011; 112: 252-256.
- 4. Heinemann LA, Dinger JC, Assmann A, et al. Use of oral contraceptives containing gestodene and risk of venous thromboembolism: outlook 10 years after the third-generation “pill scare”. Contraception 2010; 81: 401-407.
- 5. Okoroh EM, Hooper WC, Atrash HK, et al. Is polycystic ovary syndrome anther risk factor for venous thromboembolism? United States 2003-2008. Am J Obstet Gynecol 2012; 207: 377.e1-377.e8.
- 6. Furedi A. The public health implications of the 1995 ‘pill scare’. Hum Reprod Update 1999; 5: 621-626.
- 7. Mills A. Combined oral contraception and the risk of venous thromboembolism. Hum Reprod 1997; 12: 2595-2598.
- 8. van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, et al. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. BMJ 2009; 339: b2921.
- 9. Lidegaard Ø, Løkkegaard E, Svendsen AL, Agger C. Hormonal contraception and risk of venous thromboembolism: national follow-up study. BMJ 2009; 339: b2890.
- 10. Jick SS, Hernandez RK. Risk of non-fatal venous thromboembolism in women using oral contraceptives containing drospirenone compared with women using oral contraceptives containing levonorgestrel: case-control study using United States claims data. BMJ 2011; 342: d2151.
- 11. Parkin L, Sharples K, Hernandez RK, Jick SS. Risk of venous thromboembolism in users of oral contraceptives containing drospirenone or levonorgestrel: nested case-control study based on UK General Practice Research Database. BMJ 2011; 342: d2139.
- 12. Seeger JD, Loughlin J, Eng PM, et al. Risk of thromboembolism in women taking ethinylestradiol/drospirenone and other oral contraceptives. Obstet Gynecol 2007; 110: 587-593.
- 13. Dinger J, Assmann A, Möhner S, Minh TD. Risk of venous thromboembolism and the use of dienogest- and drospirenone-containing oral contraceptives: results from a German case-control study. J Fam Plann Reprod Health Care 2010; 36: 123-129.
- 14. Dinger JC, Heinemann LA, Kühl-Habich D. The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance Study on oral contraceptives based on 142,475 women-years of observation. Contraception 2007; 75: 344-354.
- 15. Dinger J, Bardenheuer K, Heinemann K. Cardiovascular and general safety of a 24-day regimen of drospirenone-containing combined oral contraceptives: final results from the International Active Surveillance Study of Women Taking Oral Contraceptives. Contraception 2014; Feb 4 [Epub ahead of print]. doi: 10.1016/j.contraception.2014.01.023.
- 16. 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.
- 17. Bitzer J, Amy JJ, Beerthuizen R, et al. Statement on combined hormonal contraceptives containing third- or fourth-generation progestogens or cyproterone acetate, and the associated risk of thromboembolism. J Fam Plann Reprod Health Care 2013; 39: 156-159. doi: 10.1136/ jfprhc-2013-100624.
- 18. Guillebaud J, MacGregor A. Contraception: your questions answered. 6th ed. London, UK: Churchill Livingstone, 2012: 186.
- 19. Risk of venous thromboembolism in users of non-oral contraceptives. Statement from the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists. http://www.fsrh.org/pdfs/CEUstatementVTEandCHC.pdf (accessed Mar 2014).
- 20. Family Planning New South Wales. Fact sheet: the pill and blood clots. http://www.fpnsw.org.au/th_pill_and_blood_clots_fs.pdf (accessed Mar 2014).
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I have been a member of a number of advisory committees for MSD and Bayer — both of which market COCPs in Australia. I have developed educational material for educational sessions sponsored by MSD and Bayer, and accepted an honorarium on these occasions. I have accepted sponsorship from a number of pharmaceutical companies to enable me to attend and present at conferences relevant to my area of expertise. I am a sub-investigator at the Women’s Health and Research Institute of Australia (attached to the Royal Hospital for Women, Sydney) which conducts pharma-sponsored clinical trials.