Phillips Angela K, Wilson Candy, Ahmed Anwar E, Shet Arun, Bevans Margaret
Operational Clinical Quality, Air Force Medical Command, Falls Church, VA (Philips).
Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL (Wilson).
AJOG Glob Rep. 2025 Apr 5;5(2):100497. doi: 10.1016/j.xagr.2025.100497. eCollection 2025 May.
Sickle cell trait is the carrier state for sickle cell disease and occurs in 1 in 13 births in Black and African American families. Individuals with sickle cell trait are permitted to serve in the military. Some research studies have shown that individuals with sickle cell trait may be at increased risk for thromboembolic events. Contraceptive use, specifically combined hormonal contraceptives containing both estrogen and progesterone, has been linked to an increased risk of thromboembolic events. No research has been done to determine if there is an increased risk of venous thromboembolism in a population of females with sickle cell trait who do or do not take combined hormonal contraceptives.
To determine if women with sickle cell trait who use combined hormonal contraceptives are at higher risk for venous thromboembolism compared with females with sickle cell trait who do not use combined hormonal contraceptives. Given the increased risk of venous thromboembolism in sickle cell trait individuals in the general population, we hypothesized that females with sickle cell trait exposed to combined hormonal contraceptives would experience higher venous thromboembolism rates than unexposed females with sickle cell trait.
Population-based retrospective cohort study of females with sickle cell trait identified from the Military Data Repository to evaluate venous thromboembolism after exposure to combined hormonal contraceptives or without exposure to combined hormonal contraceptives.
There were 15,440 unique females aged 18-44 years between 2005 and 2021 who had a diagnosis of sickle cell trait. Approximately 40% of females had an International Classification of Diseases code consistent with a prescription of a combined hormonal contraceptive. Thirty-three (0.2%) of the 15,440 females with sickle cell trait had experienced venous thromboembolism of any type. There was no difference in the prevalence of venous thromboembolism by combined hormonal contraceptive use (yes [0.18%] vs no [0.24%]; =.454). Being older, married, nonactive-duty military status, smoking, and having a diagnosis of hypertension were associated with a higher prevalence of venous thromboembolism.
Although there was a small number of venous thromboembolism events, the findings of this study suggest that the use of combined hormonal contraceptives in females with sickle cell trait is not associated with a detectable signal for increased venous thromboembolism risk as an outcome. Given the potential clinical benefit of combined hormonal contraceptives in pregnancy prevention and menstrual regulation in females, the concerns about combined hormonal contraceptive-associated venous thromboembolism in this population with sickle cell trait seem to be minimal.
镰状细胞性状是镰状细胞病的携带状态，在黑人及非裔美国家庭中，每13例出生中就有1例出现。患有镰状细胞性状的个体被允许服兵役。一些研究表明，患有镰状细胞性状的个体发生血栓栓塞事件的风险可能会增加。使用避孕药具，特别是同时含有雌激素和孕激素的复方激素避孕药，与血栓栓塞事件风险增加有关。尚未开展研究以确定在使用或未使用复方激素避孕药的患有镰状细胞性状的女性群体中，静脉血栓栓塞风险是否增加。
确定使用复方激素避孕药的患有镰状细胞性状的女性与未使用复方激素避孕药的患有镰状细胞性状的女性相比，发生静脉血栓栓塞的风险是否更高。鉴于一般人群中患有镰状细胞性状的个体发生静脉血栓栓塞的风险增加，我们假设接触复方激素避孕药的患有镰状细胞性状的女性比未接触的患有镰状细胞性状的女性发生静脉血栓栓塞的比率更高。
基于人群的回顾性队列研究，从军事数据储存库中识别出患有镰状细胞性状的女性，以评估接触复方激素避孕药或未接触复方激素避孕药后的静脉血栓栓塞情况。
在2005年至2021年期间，有15440名年龄在18至44岁之间、被诊断为镰状细胞性状的女性。约40%的女性有与复方激素避孕药处方一致的国际疾病分类代码。在15440名患有镰状细胞性状的女性中，有33名（0.2%）发生了任何类型的静脉血栓栓塞。使用复方激素避孕药与否，静脉血栓栓塞的患病率没有差异（是[0.18%]与否[0.24%]；P = 0.454）。年龄较大、已婚、非现役军人身份（此处原文有误，推测可能是“现役军人身份”）、吸烟以及被诊断为高血压与静脉血栓栓塞的患病率较高有关。
尽管静脉血栓栓塞事件数量较少，但本研究结果表明，患有镰状细胞性状的女性使用复方激素避孕药与作为结局的静脉血栓栓塞风险增加的可检测信号无关。鉴于复方激素避孕药在预防女性怀孕和调节月经方面的潜在临床益处，对于患有镰状细胞性状的这一人群中与复方激素避孕药相关的静脉血栓栓塞的担忧似乎极小。
