Manuscript Handled by: I. Pabinger Final Decision: F.R. Roseridaal, April 2013
Drospirenone and non-fatal venous thromboembolism: is there a risk difference by dosage of ethinyl-estradiol?
Article first published online: 3 JUL 2013
Copyright © 2013 International Society on Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis
Volume 11, Issue 6, pages 1059–1068, June 2013
How to Cite
Drospirenone and non-fatal venous thromboembolism: is there a risk difference by dosage of ethinyl-estradiol? J Thromb Haemost 2013; 11: 1059–68., , , , .
- Issue published online: 3 JUL 2013
- Article first published online: 3 JUL 2013
- Accepted manuscript online: 11 APR 2013 03:36AM EST
- Manuscript Received: 23 NOV 2012
- comparative study;
- venous thromboembolism
Previous studies concluded that there was an increased risk of non-fatal venous thromboembolism (VTE) with drospirenone. It is unknown whether the risk is differential by ethinyl-estradiol dosage.
To assess the risk of VTE with drospirenone and to determine whether drospirenone and ethinyl-estradiol 20 μg (DRSP/EE20) has a lower VTE risk than drospirenone and ethinyl-estradiol 30 μg (DRSP/EE30).
Our cohort included women aged 18–46 years taking drospirenone or levonorgestrel (LNG)-containing combined oral contraceptives (COCs) in the IMS claims database between 2001 and 2009. VTE was defined using ICD-9-CM coding and anticoagulation. The hazard ratio (HR) from Cox proportional hazards models was used to assess the VTE relative risk (RR) with drospirenone compared with levonorgestrel, adjusted by a propensity score used to control for baseline co-morbidity and stratified by EE dosage and user-type (new/current).
The study included 238 683 drospirenone and 193 495 levonorgestrel users. Among new and current users, a 1.90-fold (95% CI, 1.51–2.39) increased VTE relative risk was observed for drospirenone (18.0 VTE/10 000 women-years) vs. levonorgestrel (8.9 VTE/10 000 women-years). In analysis of new users, DRSP/EE20 had a 2.35-fold (95% CI, 1.44–3.82) VTE RR versus LNG/EE20. New users of DRSP/EE30 observed an increased RR versus LNG/EE30 among women starting to use COCs between 2001 and 2006 (2.51, 95% CI, 1.12–5.64) but not between 2007 and 2009 (0.76, 95% CI, 0.42–1.39), attributable to an increased incidence rate with LNG/EE30 from 2007 to 2009. In direct comparison, DRSP/EE20 had an elevated risk of VTE compared with DRSP/EE30 (RR, 1.55; 95% CI, 0.99–2.41).
We observed a modestly elevated risk of VTE with drospirenone, compared with levonorgestrel. The larger VTE incidence rate observed in DRSP/EE20 than in DRSP/EE30 and the increasing VTE incidence rate with levonorgestrel between 2007 and 2009 were unexpected.