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Progestin-only contraception and thromboembolism: A systematic review
Naomi K Tepper1, Maura K Whiteman1, Polly A Marchbanks1
1Division of Reproductive Health, US Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA.
Contraception
|May 8, 2016
Summary
Progestin-only contraceptives (POCs) generally do not increase the risk of blood clots like venous thromboembolism (VTE) or arterial events. However, injectable contraceptives and POCs used for therapeutic reasons may slightly elevate VTE risk.
Area of Science:
- Reproductive Health
- Thrombosis Research
- Pharmacovigilance
Background:
- Estrogen-containing contraceptives are contraindicated for women at high risk for thrombosis.
- Limited data exists on the thrombosis risk associated with progestin-only contraceptives (POCs).
Purpose of the Study:
- To evaluate the risk of venous thromboembolism (VTE) and arterial thromboembolism (stroke, acute myocardial infarction) associated with POC use.
- To synthesize existing evidence on thrombosis risk among women using various forms of POCs.
Main Methods:
- Systematic literature search of PubMed for studies on POCs and thrombosis risk.
- Inclusion of studies on women with and without medical conditions associated with thrombosis.
- Analysis of outcomes including VTE, stroke, and acute myocardial infarction (AMI) for different POC types (pills, injectables, implants, LNG-IUDs).
Main Results:
- Most POCs showed no increased risk of VTE or arterial events.
- Injectable depot medroxyprogesterone acetate (DMPA) was linked to elevated VTE odds in specific populations (smokers, thrombogenic mutations) and healthy women.
- POCs used for therapeutic indications showed a potential increase in VTE risk.
Conclusions:
- The majority of POCs do not appear to increase the risk of venous or arterial thrombotic events.
- Injectable contraceptives and POCs for therapeutic use warrant further investigation regarding VTE risk.
- Any identified increase in absolute risk of thrombosis is likely small at the population level.
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