Drospirenone-containing oral contraceptive pills and the risk of venous and arterial thrombosis: a systematic review

Authors

  • CQ Wu,

    1. Faculty of Medicine, McGill University, Montreal, QC, Canada
    2. Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
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  • SM Grandi,

    1. Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
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  • KB Filion,

    1. Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
    2. Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
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  • HA Abenhaim,

    1. Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
    2. Department of Obstetrics and Gynecology, Jewish General Hospital, Montreal, QC, Canada
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  • L Joseph,

    1. Division of Clinical Epidemiology, McGill University Health Center, Montreal, QC, Canada
    2. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
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  • MJ Eisenberg

    Corresponding author
    1. Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
    2. Division of Cardiology, Jewish General Hospital/McGill University, Montreal, QC, Canada
    • Faculty of Medicine, McGill University, Montreal, QC, Canada
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Correspondence: Prof MJ Eisenberg, Professor of Medicine, Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital/McGill University, 3755 Côte Ste-Catherine Road, Suite H–421.1, Montreal, Quebec H3T 1E2, Canada. Email mark.eisenberg@mcgill.ca

Abstract

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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