Keenan Lynn, Kerr Tyson, Duane Marguerite, Van Gundy Karl
Department of Medicine, University of California, San Francisco, Fresno, CA, USA.
Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
Linacre Q. 2018 Nov;85(4):470-477. doi: 10.1177/0024363918816683. Epub 2019 Jan 3.
Hormonal contraception (HC) is widely used throughout the world and has been associated with venous thrombosis (VT) such as deep vein thrombosis, pulmonary emboli, and cerebral VT.
To provide a current comprehensive overview of the risk of objectively confirmed VT with HC in healthy women compared to nonusers.
PubMed was searched from inception to April 2018 for eligible studies in the English language, with hand searching from past systematic reviews.
We selected original research evaluating risk of objectively confirmed VT in healthy women taking oral or nonoral HC compared with nonusers.
The primary outcome of interest was a fatal or nonfatal VT in users of HC compared to nonusers or past users. Studies with at least twenty events were eligible. Adjusted relative risks with 95 percent confidence intervals were reported. Three independent reviewers extracted data from selected studies.
1,962 publications were retrieved through the search strategy, with 15 publications included. Users of oral contraception with levonorgesterol had increased risk of VT by a range of 2.79-4.07, while other oral hormonal preparations increased risk by 4.0-48.6. Levonorgestrel intrauterine devices did not increase risk. Etonogestrel/ethinyl estradiol vaginal rings increased the risk of VT by 6.5. Norelgestromin/ethinyl estradiol patches increased risk of VT by 7.9. Etonogestrel subcutaneous implants by 1.4 and depot-medroxyprogesterone by 3.6. The risk of fatal VT was increased in women aged fifteen to twenty-four by 18.8-fold.
Users of HC have a significant increased risk of VT compared to nonusers. Current risks would project at least 300-400 healthy young women dying yearly in the United States due to HC. Women should be informed of these risks and offered education in fertility-awareness-based methods with comparable efficacy for family planning.
HC is widely used throughout the world and has been associated with blood clots in the legs and lungs. We searched the literature and found the risks of currently used forms of birth control increased between three- and ninefold for blood clots for healthy women. The risks found would project 300-400 women dying from using HC each year in the United States.
激素避孕法（HC）在全球广泛使用，且与静脉血栓形成（VT）有关，如深静脉血栓、肺栓塞和脑静脉血栓形成。
提供与未使用者相比，健康女性使用HC后经客观证实的VT风险的最新全面概述。
检索PubMed自创建至2018年4月的符合条件的英文研究，并从以往的系统评价中进行手工检索。
我们选择了评估健康女性口服或非口服HC与未使用者相比经客观证实的VT风险的原始研究。
感兴趣的主要结局是HC使用者与未使用者或既往使用者相比的致命或非致命VT。至少有20例事件的研究符合条件。报告了调整后的相对风险及95%置信区间。三位独立评审员从选定的研究中提取数据。
通过检索策略检索到1962篇出版物，纳入15篇。含左炔诺孕酮的口服避孕药使用者发生VT的风险增加2.79至4.07倍，而其他口服激素制剂使风险增加4.0至48.6倍。左炔诺孕酮宫内节育器不会增加风险。依托孕烯/炔雌醇阴道环使VT风险增加6.5倍。去氧孕烯/炔雌醇贴片使VT风险增加7.9倍。依托孕烯皮下植入剂使风险增加1.4倍，醋酸甲羟孕酮长效注射剂使风险增加3.6倍。15至24岁女性的致命VT风险增加了18.8倍。
与未使用者相比，HC使用者发生VT的风险显著增加。根据目前的风险推测，在美国每年至少有300 - 400名健康年轻女性因HC死亡。应告知女性这些风险，并为她们提供基于生育意识方法的教育，这些方法在计划生育方面具有相当的效果。
HC在全球广泛使用，且与腿部和肺部血栓有关。我们检索了文献，发现目前使用的避孕方式使健康女性发生血栓的风险增加了三至九倍。根据所发现的风险推测，在美国每年有300 - 400名女性因使用HC而死亡。
