Combined Hormonal Contraception And The Risk Of Venous Thromboembolism
Publication Date: January 1, 2017
Last Updated: March 14, 2022
Summary
High-dose combined oral contraception (>50 μg) is associated with higher risks of VTE than lower-dose formulations. (, B)
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Evidence is conflicting whether preparations of COC with 50 μg EE have a higher risk of thrombosis compared with sub-50 μg EE formulations, although several large studies have seen an increased risk of VTE in 50 μg EE COCs. (, B)
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There is no reliable evidence that EE doses lower than 35 μg have less VTE risk than 35 μg formulations. (, B)
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There is fair evidence that preparations of COCs with drospirenone or third-generation progestins have only a slightly higher risk of VTE compared with those containing norethindrone or levonorgestrel. (, B)
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There is insufficient evidence that the contraceptive patch or contraceptive vaginal ring has a different risk of VTE compared with COCs. (, C)
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There is fair evidence that tobacco use, age (>35 years), obesity, hypertension, and the presence of hereditary thrombophilias (including factor V Leiden mutation, prothrombin G20210A mutation and protein C, protein S, or antithrombin deficiency) increase the risk of thrombotic events in the setting of CHC use. (, B)
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Recommendation
In the patient in whom combined hormonal contraception is appropriate, it is reasonable to use any currently available preparation. (, )
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Title
Combined Hormonal Contraception And The Risk Of Venous Thromboembolism
Authoring Organization
American Society for Reproductive Medicine
Publication Month/Year
January 1, 2017
Last Updated Month/Year
January 16, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
While venous thromboembolism (VTE) is rare in young women of reproductive age, combined oral contraceptives increase the risk of VTE. In the patient in whom combined hormonal contraception is appropriate, it is reasonable to use any currently available preparation.
Target Patient Population
Patients on hormonal contraception
Inclusion Criteria
Female, Adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Management
Diseases/Conditions (MeSH)
D054556 - Venous Thromboembolism, D020246 - Venous Thrombosis, D000080066 - Contraceptive Agents, Hormonal, D003271 - Contraceptive Agents, Female
Keywords
oral contraceptive, hormonal therapy, Venous Thromboembolism
Methodology
Number of Source Documents
91
Literature Search Start Date
February 1, 2015
Literature Search End Date
June 1, 2015