Injectable Progestin-Only Contraceptives May Increase Risk for VTE

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Patients who used oral progestin-only oral contraceptive had a higher risk for VTE and stroke than for myocardial infarction.
Patients who used oral progestin-only oral contraceptive had a higher risk for VTE and stroke than for myocardial infarction.

Oral progestin-only contraceptives (POC) are not associated with an increased risk for cardiometabolic outcomes, but injectable POC use may increase the risk for venous thromboembolism and diabetes, according to new findings published the European Journal of Preventive Cardiology.

The association between POC and the risk for various cardiometabolic outcomes has not been well defined or studied. To assess the effect of POCs on cardiometabolic outcomes including venous thromboembolism, myocardial infarction, stroke, hypertension, and diabetes, a systematic review of the literature and meta-analysis was performed.

A total of 19 observational studies (7 cohort and 12 case control) were included in this systematic review, with a total cohort of 62,088 women that included 11,930 who used POCs.

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Of the included studies, 9 reported the risk for venous thromboembolism, 6 for myocardial infarction, 6 for stroke, 3 for hypertension, and 2 for diabetes with POC use. The pooled adjusted relative risks (RRs) for venous thromboembolism, myocardial infarction, and stroke with oral POC use vs non-use were 1.06 (95% CI, 0.70-1.62), 0.98 (95% CI, 0.66-1.47), and 1.02 (95% CI, 0.72-1.44), respectively.

A stratified analysis that looked at the route of administration found that injectable POC had an RR of 2.62 (95% CI, 1.74-3.94) for risk for venous thromboembolism. There was also a lower risk for venous thromboembolism among a subgroup using an intrauterine levonorgestrel device (RR 0.53; 95% CI, 0.32-0.89. The use of POC did not appear to have an effect on blood pressure but there was a non-significant increase in risk for diabetes with injectable POCs.

Based on these findings, “further investigation is required in order to rule out potential harmful effects of [depot medroxyprogesterone]… which has a relatively higher dose of progestin… in these women,” the authors concluded.

Reference

Glisic M, Shahzad S, Tsoli S, et al. Association between progestin-only contraceptive use and cardiometabolic outcomes: a systematic review and meta-analysis [published online May 10, 2018]. Eur J Prev Cardiol. doi: 10.1177/2047487318774847

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