Key result
Drospirenone-containing oral contraceptive pills were associated with a higher risk for VTE compared with no OCP use (rate ratio 4.0-6.3) and levonorgestrel-containing OCP use (rate ratio 1.0-3.3).
Why the study?
Does the use of drospirenone-containing oral contraceptive pills increase the risk of venous thromboembolism, myocardial infarction, and stroke compared to no use or levonorgestrel-containing pills?
Systematic Review
Does the use of drospirenone-containing oral contraceptive pills increase the risk of venous thromboembolism, myocardial infarction, and stroke compared to no use or levonorgestrel-containing pills?
Effect estimate: Rate ratio 1.0 to 3.3
Drospirenone-containing oral contraceptive pills are associated with a higher risk of venous thromboembolism compared to non-use and levonorgestrel-containing pills.
Supports preferring levonorgestrel OCPs in VTE-prone women; confirms drospirenone's higher thrombotic risk versus non-use or levonorgestrel.
BACKGROUND: Previous studies have provided conflicting results regarding the effect of drospirenone-containing oral contraceptive pills (OCPs) on the risk of venous and arterial thrombosis. OBJECTIVES: To conduct a systematic review to assess the risk of venous thromboembolism (VTE), myocardial infarction (MI), and stroke in individuals taking drospirenone-containing OCPs. SEARCH STRATEGY: We systematically searched CINAHL, the Cochrane Library, Dissertation & Abstracts, EMBASE, HealthStar, Medline, and the Science Citation Index from inception to November 2012. SELECTION CRITERIA: We included all case reports, observational studies, and experimental studies assessing the risk of venous and arterial thrombosis of drospirenone-containing OCPs. DATA COLLECTION AND ANALYSIS: Data were collected independently by two reviewers. MAIN RESULTS: A total of 22 studies [six case reports, three case series (including 26 cases), and 13 comparative studies] were included in our systematic review. The 32 identified cases suggest a possible link between drospirenone-containing OCPs and venous and arterial thrombosis. Incidence rates of VTE among drospirenone-containing OCP users ranged from 23.0 to 136.7 per 100 000 woman-years, whereas those among levonorgestrel-containing OCP users ranged from 6.64 to 92.1 per 100 000 woman-years. The rate ratio for VTE among drospirenone-containing OCP users ranged from 4.0 to 6.3 compared with non-users of OCPs, and from 1.0 to 3.3 compared with levonorgestrel-containing OCP users. The arterial effects of drospirenone-containing OCPs were inconclusive. AUTHOR'S CONCLUSIONS: Our systematic review suggests that drospirenone-containing OCP use is associated with a higher risk for VTE than both no OCP use and levonorgestrel-containing OCP use.
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Wu et al. (2013) conducted a systematic review in Venous and arterial thrombosis. Drospirenone-containing oral contraceptive pills vs. No OCP use or levonorgestrel-containing OCP use was evaluated on Venous thromboembolism (VTE) (Rate ratio 1.0 to 3.3). Drospirenone-containing oral contraceptive pills were associated with a higher risk for VTE compared with no OCP use (rate ratio 4.0-6.3) and levonorgestrel-containing OCP use (rate ratio 1.0-3.3).
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