Vinogradova Yana, Coupland Carol, Hippisley-Cox Julia
Division of Primary Care, University Park, Nottingham, NG2 7RD UK
Division of Primary Care, University Park, Nottingham, NG2 7RD UK.
BMJ. 2015 May 26;350:h2135. doi: 10.1136/bmj.h2135.
To investigate the association between use of combined oral contraceptives and risk of venous thromboembolism, taking the type of progestogen into account.
Two nested case-control studies.
General practices in the United Kingdom contributing to the Clinical Practice Research Datalink (CPRD; 618 practices) and QResearch primary care database (722 practices).
Women aged 15-49 years with a first diagnosis of venous thromboembolism in 2001-13, each matched with up to five controls by age, practice, and calendar year.
Odds ratios for incident venous thromboembolism and use of combined oral contraceptives in the previous year, adjusted for smoking status, alcohol consumption, ethnic group, body mass index, comorbidities, and other contraceptive drugs. Results were combined across the two datasets.
5062 cases of venous thromboembolism from CPRD and 5500 from QResearch were analysed. Current exposure to any combined oral contraceptive was associated with an increased risk of venous thromboembolism (adjusted odds ratio 2.97, 95% confidence interval 2.78 to 3.17) compared with no exposure in the previous year. Corresponding risks associated with current exposure to desogestrel (4.28, 3.66 to 5.01), gestodene (3.64, 3.00 to 4.43), drospirenone (4.12, 3.43 to 4.96), and cyproterone (4.27, 3.57 to 5.11) were significantly higher than those for second generation contraceptives levonorgestrel (2.38, 2.18 to 2.59) and norethisterone (2.56, 2.15 to 3.06), and for norgestimate (2.53, 2.17 to 2.96). The number of extra cases of venous thromboembolism per year per 10,000 treated women was lowest for levonorgestrel (6, 95% confidence interval 5 to 7) and norgestimate (6, 5 to 8), and highest for desogestrel (14, 11 to 17) and cyproterone (14, 11 to 17).
In these population based, case-control studies using two large primary care databases, risks of venous thromboembolism associated with combined oral contraceptives were, with the exception of norgestimate, higher for newer drug preparations than for second generation drugs.
考虑孕激素类型，研究复方口服避孕药的使用与静脉血栓栓塞风险之间的关联。
两项巢式病例对照研究。
向临床实践研究数据链（CPRD；618家诊所）和QResearch初级保健数据库（722家诊所）提供数据的英国全科医疗诊所。
2001年至2013年首次诊断为静脉血栓栓塞的15至49岁女性，每名病例按年龄、诊所和日历年与多达五名对照进行匹配。
前一年发生静脉血栓栓塞和使用复方口服避孕药的比值比，并根据吸烟状况、饮酒量、种族、体重指数、合并症和其他避孕药物进行调整。两个数据集的结果进行了合并。
分析了来自CPRD的5062例静脉血栓栓塞病例和来自QResearch的5500例病例。与前一年未暴露相比，当前暴露于任何复方口服避孕药均与静脉血栓栓塞风险增加相关（调整后的比值比为2.97，95%置信区间为2.78至3.17）。当前暴露于去氧孕烯（4.28，3.66至5.01）、孕二烯酮（3.64，3.00至4.43）、屈螺酮（4.12，3.43至4.96）和环丙孕酮（4.27，3.57至5.11）的相应风险显著高于第二代避孕药左炔诺孕酮（2.38，2.18至2.59）、炔诺酮（2.56，2.15至3.06）以及诺孕酯（2.53，2.17至2.96）。每10000名接受治疗的女性每年额外发生的静脉血栓栓塞病例数，左炔诺孕酮（6，95%置信区间为5至7）和诺孕酯（6，5至8）最低，去氧孕烯（14，11至17）和环丙孕酮（14，11至17）最高。
在这些基于人群的、使用两个大型初级保健数据库的病例对照研究中，除诺孕酯外，与复方口服避孕药相关的静脉血栓栓塞风险，新型药物制剂高于第二代药物。
Zotero 插件
