Trager Robert J, Haering Catherine P, Baumann Anthony N, Wright Debbie S
Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Family Medicine and Community Health, Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of Biostatistics and Bioinformatics Clinical Research Training Program, Duke University School of Medicine, Durham, NC, USA.
Department of Reproductive Endocrinology and Infertility, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Thromb Res. 2025 Mar;247:109279. doi: 10.1016/j.thromres.2025.109279. Epub 2025 Feb 7.
To date, research has identified positive associations between combined oral contraceptives (COCs) and adverse vascular events, however, evidence regarding the possible association with cervical artery dissection (CeAD) remains limited. We tested the hypothesis of a positive association between COCs and CeAD within one year following COC initiation compared to matched controls initiating intrauterine devices (IUDs), as measured by risk ratio (RR).
We queried de-identified United States health records data (TriNetX, Inc.) from 2014 to 2024 for females aged 15-50 years without previous cerebrovascular disease or CeAD, creating mutually exclusive cohorts initiating either COCs or IUDs. We used propensity matching to control for variables associated with CeAD. Our primary outcome included the RR for CeAD within one year follow-up. We secondarily explored cumulative CeAD incidence and RR of stroke, also examining outcomes for females with ≥2 COC prescriptions (COC2).
After matching there were 214,020 patients per cohort (mean age 31 years). The incidence and risk of CeAD was greater among those prescribed COCs compared to matched controls with IUDs [95 % CI] (COCs: 0.016 %, IUDs: 0.008 %; RR 1.94 [1.10,3.43]; P = 0.0195). A similar association was observed for stroke (COCs: 0.106 %, IUDs: 0.057 %; RR = 1.86 [1.49,2.32]; P < 0.0001). The secondary COC2 analysis revealed similar findings.
The present findings suggest that females prescribed COCs have an increased risk of CeAD and stroke compared to matched controls using IUDs. These observations should be viewed as preliminary, require corroboration by other studies, and in isolation do not replace the broader clinical and shared decision-making regarding contraceptive use.
迄今为止，研究已确定复方口服避孕药（COC）与不良血管事件之间存在正相关，但关于其与颈动脉夹层（CeAD）可能关联的证据仍然有限。我们检验了一个假设，即与使用宫内节育器（IUD）的匹配对照组相比，在开始使用COC后一年内，COC与CeAD之间存在正相关，以风险比（RR）衡量。
我们查询了2014年至2024年美国去识别化的健康记录数据（TriNetX公司），对象为15至50岁、既往无脑血管疾病或CeAD的女性，创建了开始使用COC或IUD的相互排斥队列。我们使用倾向匹配法来控制与CeAD相关的变量。我们的主要结局包括随访一年内CeAD的RR。我们还次要探索了CeAD的累积发病率和中风的RR，也检查了有≥2张COC处方的女性（COC2）的结局。
匹配后，每个队列有214,020名患者（平均年龄31岁）。与使用IUD的匹配对照组相比，使用COC的患者中CeAD的发病率和风险更高[95%置信区间]（COC组：0.016%，IUD组：0.008%；RR 1.94[1.10,3.43]；P = 0.0195）。中风方面也观察到类似关联（COC组：0.106%，IUD组：0.057%；RR = 1.86[1.49,2.32]；P < 0.0001）。次要的COC2分析得出了类似结果。
目前的研究结果表明，与使用IUD的匹配对照组相比，使用COC的女性发生CeAD和中风的风险增加。这些观察结果应被视为初步的，需要其他研究的确证，且单独来看并不能取代关于避孕使用更广泛临床和共同决策。
