Sugiura Kazuko, Ojima Toshiyuki, Urano Tetsumei, Kobayashi Takao
Department of Reproductive Health Nursing/Midwifery, Nagoya City University Graduate School of Nursing, Nagoya, Japan.
Department of Community Health and Preventive Medicine, Shizuoka, Japan.
J Obstet Gynaecol Res. 2018 Sep;44(9):1766-1772. doi: 10.1111/jog.13706. Epub 2018 Jul 12.
We analyzed the incidence and prognosis of thromboembolism associated with combined oral contraceptives (COCs) by age groups in Japan.
A total of 581 events of venous thromboembolism (VTE) and arterial thromboembolism (ATE) associated with COCs were analyzed from the Pharmaceuticals and Medical Devices Agency database from 2004 to 2013. In a statistical analysis, a good-prognosis group included recovery cases and a poor-prognosis group involved unrecovered cases with some sequela and fatal cases. The significant difference between these two groups was calculated by Pearson's chi-square test, and the age-specific tendency and the trend of differences in prognosis according to different hormonal contraceptives were examined by Cochran-Armitage trend test.
A total of 543 events were analyzed except 38 events due to unknown age, in which DVT only was the most frequent, followed by cerebral infarction, PE with DVT, PE only, cerebral vein thromboses. ATE ratio for overall thromboembolism tended to increase with advancing age (P = 0.0041). Good-prognosis group was common (291 cases in VTE and 83 cases in ATE), followed by poor-prognosis group (46 cases in VTE and 34 cases in ATE). All ATE cases had a significantly poorer prognosis in comparison with all VTE cases (P < 0.0001). Types of progestin and age difference, however, showed no trend in the differences between good-prognosis group and poor-prognosis group (P = 0.3548 and P = 0.6097).
Thromboembolic events were the most frequent in the 40s. The ATE ratio for overall thromboembolism tended to increase with advancing age. All ATE cases had a significantly poorer prognosis in comparison with all VTE cases.
我们按年龄组分析了日本口服复方避孕药（COC）相关血栓栓塞的发生率及预后情况。
从药品和医疗器械管理局数据库中分析了2004年至2013年期间581例与COC相关的静脉血栓栓塞（VTE）和动脉血栓栓塞（ATE）事件。在统计分析中，预后良好组包括康复病例，预后不良组包括未康复且有后遗症的病例以及死亡病例。两组间的显著差异采用Pearson卡方检验计算，不同激素避孕药的年龄特异性趋势及预后差异趋势采用Cochran - Armitage趋势检验。
除38例年龄未知的事件外，共分析了543例事件，其中仅深静脉血栓形成（DVT）最为常见，其次是脑梗死、合并DVT的肺栓塞（PE）、单纯PE、脑静脉血栓形成。总体血栓栓塞的ATE比例随年龄增长呈上升趋势（P = 0.0041）。预后良好组较为常见（VTE组291例，ATE组83例），其次是预后不良组（VTE组46例，ATE组34例）。与所有VTE病例相比，所有ATE病例的预后明显更差（P < 0.0001）。然而孕激素类型和年龄差异在预后良好组与预后不良组之间未显示出差异趋势（P = 0.3548和P = 0.6097）。
血栓栓塞事件在40多岁人群中最为常见。总体血栓栓塞的ATE比例随年龄增长呈上升趋势。与所有VTE病例相比，所有ATE病例的预后明显更差。
