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Meta-Analysis
. 2018 Jun;141(3):287-294.
doi: 10.1002/ijgo.12455. Epub 2018 Feb 22.

A systematic review and meta-analysis of venous thrombosis risk among users of combined oral contraception

Monica V Dragoman  1 , Naomi K Tepper  2 , Rongwei Fu  3 , Kathryn M Curtis  2 , Roger Chou  3 , Mary E Gaffield  1
Affiliations
Meta-Analysis

A systematic review and meta-analysis of venous thrombosis risk among users of combined oral contraception

Monica V Dragoman et al. Int J Gynaecol Obstet. 2018 Jun.

Abstract

Background: Combined oral contraceptives (COCs) containing various progestogens could be associated with differential risks for venous thromboembolism (VTE).

Objective: To evaluate the comparative risks of VTE associated with the use of low-dose (less than 50 μg ethinyl estradiol) COCs containing different progestogens.

Search strategy: PubMed and the Cochrane Library were searched from database inception through September 15, 2016, by combining search terms for oral contraception and venous thrombosis.

Selection criteria: Studies reporting VTE risk estimates among healthy users of progestogen-containing low-dose COCs were included.

Data collection and analysis: A random-effects model was used to generate pooled adjusted risk ratios and 95% confidence intervals; subgroup and sensitivity analyses assessed the impact of monophasic-COC use and study-level characteristics.

Main results: There were 22 articles included in the analysis. The use of COCs containing cyproterone acetate, desogestrel, drospirenone, or gestodene was associated with a significantly increased risk of VTE compared with the use of levonorgestrel-containing COCs (pooled risk ratios 1.5-2.0). The analysis restricted to monophasic COC formulations with 30 μg of ethinyl estradiol yielded similar findings. After adjustment for study characteristics, the risk estimates were slightly attenuated.

Conclusions: Compared with the use of levonorgestrel-containing COCs, the use of COCs containing other progestogens could be associated with a small increase in risk for VTE.

Keywords: Combined oral contraceptives; Hormonal contraception; Meta-analysis; Risk; Systematic review; Venous thromboembolism.

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Figures

Figure 1
Figure 1
Flow diagram of publication selection for inclusion.
See this image and copyright information in PMC

References

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