nuvaring and Venous-Thromboembolism

Nuvaring (Organon, Kenilworth, NJ) is a vaginal contraception ring inserted by the patient. It was approved by the Food and Drug Administration in 2001 for the prevention of pregnancy. The intent of this paper is to increase the awareness of Nuvaring among plastic surgeons, and to explore the risks associated with its use. We report the cases of two cosmetic surgery patients. These patients developed deep venous thrombosis and pulmonary emboli in the postoperative period while using Nuvaring. The very advantages of the Nuvaring-the ease of use, the avoidance of daily administration, and the insertion and removal of the device by the patient-may lead to the failure of patients to recollect being on a vaginal ring for contraception.. 4 Risk.

Topics: Abdominoplasty; Administration, Intravaginal; Adult; Anticoagulants; Breast Implantation; Contraceptive Devices, Female; Desogestrel; Drug Combinations; Embolectomy; Ethinyl Estradiol; Female; Humans; Pulmonary Embolism; Risk Assessment; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome; Venous Thromboembolism; Venous Thrombosis

We present a case of a 27-year-old women admitted to the hospital with migraine and left upper extremity weakness. Subsequent imaging with computed tomography and magnetic resonance angiography/venography demonstrated an acute-appearing central venous sinus thrombosis. Her only risk factor for venous thromboembolism (VTE) was the use of etonogestrel/ethinyl estradiol vaginal contraceptive ring (NuvaRing). The contraceptive ring was removed and the patient was treated according to the current guidelines. She achieved full neurologic recovery at 6 months' follow-up. Here, we describe this unusual case and review the risk of VTE between combined vaginal contraception and combined oral contraception.

Topics: Adult; Desogestrel; Drug Combinations; Ethinyl Estradiol; Female; Humans; Risk Factors; Sinus Thrombosis, Intracranial; Venous Thromboembolism

To compare the risks of short-term and long-term use of an etonogestrel-containing and ethinylestradiol-containing vaginal ring and combined oral contraceptive pills (OCPs) in a routine clinical study population.. This was a prospective, controlled, noninterventional cohort study performed in the United States and five European countries with the following two cohorts: new users of the vaginal ring and new users of combined OCPs (starters, switchers, or restarters). The study population included 33,295 users of the vaginal ring or combined OCPs recruited by 1,661 study centers. Follow-up of study participants occurred for 2 to 4 years. Main clinical outcomes of interest were cardiovascular outcomes, particularly venous and arterial thromboembolism. These outcomes were validated by attending physicians and further adjudicated by an independent board. Comprehensive follow-up ensured low loss to follow-up. Statistical analyses were based on Cox regression models. Primary statistical variable was the venous thromboembolic hazard ratio (HR) for the vaginal ring compared with combined OCPs.. Study participants were followed-up for 66,489 woman-years. Loss to follow-up was 2.9%. The venous thromboembolism incidence rates for the vaginal ring users and combined OCPs users were 8.3 and 9.2 per 10,000 woman-years, respectively. Cox regression analysis yielded crude and adjusted HRs for the vaginal ring users compared with combined OCPs users of 0.9 and 0.8 for venous thromboembolism (95% confidence intervals [CIs] 0.5-1.6 and 0.5-1.5) and 0.8 and 0.7 (95% CIs 0.2-2.5 and 0.2-2.3) for arterial thromboembolism, respectively.. Vaginal ring use and combined OCP use were associated with a similar venous and arterial thromboembolic risk during routine clinical use.. : II.

Topics: Adult; Contraceptives, Oral, Combined; Desogestrel; Drug Combinations; Ethinyl Estradiol; Female; Humans; Product Surveillance, Postmarketing; Prospective Studies; Risk Assessment; Venous Thromboembolism; Young Adult