gestodene and Venous-Thromboembolism

Venous thromboembolism and arterial ischemic events are the main deleterious diseases associated with the use of combined hormonal contraceptives (CHC). Even though their composition has been substantially improved, the vascular risk persists with the most recent CHCs use. If the vascular risk associated with CHCs containing 50μg EE is significantly higher than with those containing less than 50μg, there is no evidence that the CHCs containing either 30 or 20μg of EE induce different venous risks. CHC containing gestodene, desogestrel, drospirenone or cyproterone acetate are associated with a higher risk of venous thrombosis compared with levonorgestrel-containing CHCs. CHC containing norgestimate are associated with similar venous thrombosis risk than CHC containing levonorgestrel. Venous thrombosis risk of non-oral routes of administration of CHC appears to be equivalent to the risk of CHC containing gestodene or desogestrel, but this result is based on a small number of epidemiological studies. Before prescribing a CHC, it is important to determine all vascular risk factors. Family history of ischemic arterial event or venous thromboembolism disease should be routinely sought before any CHC prescription. All CHCs are contraindicated in women with biological thrombophilia, in women with combined vascular risk factors, in women with first-degree family history of arterial or venous event (under age 50) as well as in women suffering of migraine with aura. Progestin-only contraceptives are not associated with vascular risk (arterial or venous) outside of medroxyprogesterone acetate. In women with higher vascular risk, progestin-only contraceptives (administered by oral, sous-cutaneous or intra-uterine routes) can be prescribed.

Topics: Androstenes; Contraceptive Agents, Female; Contraceptives, Oral, Combined; Contraceptives, Oral, Hormonal; Cyproterone Acetate; Desogestrel; Female; France; Humans; Levonorgestrel; Norpregnenes; Progestins; Risk Factors; Vascular Diseases; Venous Thromboembolism

Topics: Adolescent; Adult; Age Factors; Androstenes; Body Mass Index; Contraceptives, Oral, Combined; Data Collection; Data Interpretation, Statistical; Desogestrel; Female; Humans; Middle Aged; Norpregnenes; Progesterone Congeners; Reproducibility of Results; Risk Factors; Venous Thromboembolism; Young Adult

To assess the risk of venous thromboembolism from use of combined oral contraceptives according to progestogen type and oestrogen dose.. National historical registry based cohort study.. Four registries in Denmark.. Non-pregnant Danish women aged 15-49 with no history of thrombotic disease and followed from January 2001 to December 2009.. Relative and absolute risks of first time venous thromboembolism.. Within 8,010,290 women years of observation, 4307 first ever venous thromboembolic events were recorded and 4246 included, among which 2847 (67%) events were confirmed as certain. Compared with non-users of hormonal contraception, the relative risk of confirmed venous thromboembolism in users of oral contraceptives containing 30-40 µg ethinylestradiol with levonorgestrel was 2.9 (95% confidence interval 2.2 to 3.8), with desogestrel was 6.6 (5.6 to 7.8), with gestodene was 6.2 (5.6 to 7.0), and with drospirenone was 6.4 (5.4 to 7.5). With users of oral contraceptives with levonorgestrel as reference and after adjusting for length of use, the rate ratio of confirmed venous thromboembolism for users of oral contraceptives with desogestrel was 2.2 (1.7 to 3.0), with gestodene was 2.1 (1.6 to 2.8), and with drospirenone was 2.1 (1.6 to 2.8). The risk of confirmed venous thromboembolism was not increased with use of progestogen only pills or hormone releasing intrauterine devices. If oral contraceptives with desogestrel, gestodene, or drospirenone are anticipated to increase the risk of venous thromboembolism sixfold and those with levonorgestrel threefold, and the absolute risk of venous thromboembolism in current users of the former group is on average 10 per 10,000 women years, then 2000 women would need to shift from using oral contraceptives with desogestrel, gestodene, or drospirenone to those with levonorgestrel to prevent one event of venous thromboembolism in one year.. After adjustment for length of use, users of oral contraceptives with desogestrel, gestodene, or drospirenone were at least at twice the risk of venous thromboembolism compared with users of oral contraceptives with levonorgestrel.

Topics: Adolescent; Adult; Androstenes; Anticoagulants; Cohort Studies; Confounding Factors, Epidemiologic; Contraceptives, Oral; Denmark; Desogestrel; Dose-Response Relationship, Drug; Epidemiologic Methods; Female; Humans; Intrauterine Devices, Medicated; Levonorgestrel; Middle Aged; Mineralocorticoid Receptor Antagonists; Norpregnenes; Pregnancy; Time Factors; Venous Thromboembolism; Young Adult

Topics: Androstenes; Contraceptives, Oral; Cyproterone; Denmark; Desogestrel; Ethinyl Estradiol; Female; Humans; Levonorgestrel; Norpregnenes; Progestins; Registries; Risk; Venous Thromboembolism

This study investigated whether gestodene-containing oral contraceptives (OCs) carry a higher risk of venous thromboembolism (VTE) than OCs containing progestins other than desogestrel and gestodene. The study was conducted based on the hypothesis that the biases and confounding factors that were present initially after the introduction of new so-called "third-generation" OCs (i.e., those containing desogestrel and gestodene) in the 1990s, which likely contributed to the alleged increased risk of VTE, may have vanished after 10 years.. This was a matched case-control study using data identified for women (aged 15-49 years) with suspected or diagnosed VTE (deep vein thrombosis or pulmonary embolism) that occurred between January 2002 and February 2006 in Austria. All VTE cases were validated by an attending/relevant physician(s), a detailed review of medical records and patient-completed questionnaires. Data were analyzed using an unconditional logistic regression model with adjustment for relevant confounders.. Overall, 451 VTE cases and 1,920 controls without VTE were identified. The adjusted odds ratios for confirmed VTE with OC use versus nonuse were: 3.39 (95% CI 2.36-4.87) for OCs containing gestodene and 3.14 (2.1-4.47) for OCs containing progestins other than desogestrel and gestodene. Adjusted odds ratios for a head-to-head comparison of OCs containing gestodene versus OCs containing progestins other than desogestrel and gestodene were: 0.99 (0.68-1.45) for all cases; 1.01 (0.69-1.47) for confirmed cases and 1.11 (0.73-1.69) for confirmed and idiopathic VTE cases, respectively.. The risk of VTE is not elevated in users of gestodene-containing OCs relative to users of OCs containing progestins other than desogestrel and gestodene. Our study supports the view that (i) the majority of previous results may be explained by differences in the user populations of so-called "third-generation" OCs (containing desogestrel and gestodene) and "second-generation" OCs (containing progestins other than desogestrel and gestodene) that were present shortly after market introduction of gestodene-containing OCs and that (ii) these differences seem to have disappeared over time.

Topics: Adolescent; Adult; Austria; Case-Control Studies; Contraceptives, Oral, Synthetic; Female; Humans; Middle Aged; Norpregnenes; Pregnancy; Pulmonary Embolism; Risk Assessment; Venous Thromboembolism; Young Adult

Topics: Contraceptives, Oral, Synthetic; Cyproterone Acetate; Desogestrel; Female; Hemostasis; Humans; Norpregnenes; Risk Factors; Venous Thromboembolism; Young Adult