口服避孕药使用与急性血栓栓塞事件风险：系统评价和荟萃分析。
Risk of acute thromboembolic events with oral contraceptive use: a systematic review and meta-analysis.
机构信息
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; and Duke Evidence-based Practice Center, Duke Clinical Research Institute, the Department of Community and Family Medicine, Doctor of Physical Therapy Division, and the Departments of Medicine, Obstetrics and Gynecology, and Biostatistics and Bioinformatics, Duke University School of Medicine, the Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Duke Cancer Institute, Duke University Health System, and Duke Clinical Research Institute, Durham, North Carolina.
出版信息
Obstet Gynecol. 2013 Aug;122(2 Pt 1):380-389. doi: 10.1097/AOG.0b013e3182994c43.
OBJECTIVE
To estimate the risk of venous thromboembolism, stroke, or myocardial infarction (MI) associated with the use of oral contraceptive pills (OCPs) and to describe how these risks vary by dose or formulation.
DATA SOURCES
We searched PubMed, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov for studies published from January 1995 through June 2012 that evaluated the association between OCP use and risk of venous thromboembolism, stroke, or MI.
METHODS OF STUDY SELECTION
We reviewed 6,476 citations. We included English-language, controlled studies with human participants reporting a quantitative association between exposure to OCPs and outcomes of venous thromboembolism, stroke, or MI. Two investigators independently reviewed articles for inclusion or exclusion; discordant decisions were resolved by team review and consensus. Random-effects meta-analysis was used to generate summary odds ratios (ORs).
TABULATION, INTEGRATION, AND RESULTS: Fifty studies met inclusion criteria. There were no randomized clinical trials. We found threefold increased odds of venous thromboembolism among current compared with noncurrent OCP users (14 studies; OR 2.97, 95% confidence interval [CI] 2.46-3.59). We found twofold increased odds of ischemic stroke (seven studies; OR 1.90, 95% CI 1.24-2.91). There was no evidence of increased risk of hemorrhagic stroke (four studies; OR 1.03, 95% CI 0.71-1.49) or MI (eight studies; OR 1.34, 95% CI 0.87-2.08).
CONCLUSION
Current use of combined OCPs is associated with increased odds of venous thromboembolism and ischemic stroke but not hemorrhagic stroke or MI.
目的
评估口服避孕药（OCP）使用与静脉血栓栓塞、中风或心肌梗死（MI）风险之间的关联，并描述这些风险如何因剂量或制剂而变化。
资料来源
我们检索了 PubMed、Embase、Cochrane 系统评价数据库和 ClinicalTrials.gov，以获取 1995 年 1 月至 2012 年 6 月期间评估 OCP 使用与静脉血栓栓塞、中风或 MI 风险之间关联的研究。
研究选择方法
我们审查了 6476 条引文。我们纳入了英语、对照研究，其中包括有人类参与者的研究，报告了 OCP 暴露与静脉血栓栓塞、中风或 MI 结果之间的定量关联。两名调查员独立审查文章的纳入或排除；有分歧的决定通过团队审查和共识解决。使用随机效应荟萃分析生成汇总优势比（OR）。
列表、整合和结果：50 项研究符合纳入标准。没有随机临床试验。我们发现，与非当前 OCP 使用者相比，当前 OCP 使用者发生静脉血栓栓塞的几率增加了三倍（14 项研究；OR 2.97，95%置信区间 [CI] 2.46-3.59）。我们发现，缺血性中风的几率增加了两倍（7 项研究；OR 1.90，95%CI 1.24-2.91）。没有证据表明出血性中风（4 项研究；OR 1.03，95%CI 0.71-1.49）或 MI（8 项研究；OR 1.34，95%CI 0.87-2.08）的风险增加。
结论
当前使用复方 OCP 与静脉血栓栓塞和缺血性中风的几率增加有关，但与出血性中风或 MI 无关。
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