Department of Epidemiology and Public Health, University College London, London, UK.
BMJ. 2013 Sep 12;347:f5298. doi: 10.1136/bmj.f5298.
To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives.
Systematic review and network meta-analysis.
PubMed, Embase, Web of Science, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, and ScienceDirect up to 22 April 2013.
Observational studies that assessed the effect of combined oral contraceptives on venous thrombosis in healthy women. The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported. The requirement for crude numbers did not allow adjustment for potential confounding variables.
3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 1.9 and 3.7 per 10,000 woman years, in line with previously reported incidences of 1-6 per 10,000 woman years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 µg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene, desogestrel, and levonorgestrel, with higher doses being associated with higher thrombosis risk.
All combined oral contraceptives investigated in this analysis were associated with an increased risk of venous thrombosis. The effect size depended both on the progestogen used and the dose of ethinylestradiol.
全面概述使用不同复方口服避孕药的女性发生静脉血栓栓塞的风险。
系统评价和网络荟萃分析。
PubMed、Embase、Web of Science、Cochrane、Cumulative Index to Nursing and Allied Health Literature、Academic Search Premier 和 ScienceDirect，检索时间截至 2013 年 4 月 22 日。
观察性研究评估了复方口服避孕药对健康女性静脉血栓栓塞的影响。主要结局指标为致命或非致命的首次静脉血栓栓塞事件，主要为深静脉血栓或肺栓塞。总事件数至少为 10 例的研究纳入分析。采用扩展的频率论随机效应模型对混合多治疗比较进行网络荟萃分析。报告未经调整的相对风险和 95%置信区间。由于需要原始数据，因此无法对潜在混杂因素进行调整。
通过检索策略共获取 3110 篇文献，其中 25 篇文献报道了 26 项研究，共 25 项研究纳入分析。2 项纳入研究的非使用者静脉血栓栓塞年发生率分别为 1.9 和 3.7/10000 妇女年，与先前报道的 1-6/10000 妇女年发生率一致。与非使用者相比，使用复方口服避孕药会增加静脉血栓栓塞的风险（相对风险 3.5，95%置信区间 2.9 至 4.3）。与左炔诺孕酮相比，含 30-35µg 炔雌醇和孕二烯酮、去氧孕烯、醋酸环丙孕酮或屈螺酮的复方口服避孕药的静脉血栓栓塞相对风险相似，约高 50-80%；而含炔雌醇的复方口服避孕药的静脉血栓栓塞相对风险则与剂量相关，高剂量与更高的血栓风险相关。
本分析中研究的所有复方口服避孕药均与静脉血栓栓塞风险增加相关。这种效应大小既取决于所使用的孕激素，也取决于炔雌醇的剂量。
