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Stroke in combined hormonal contraceptive users treated with triptans
Gasper Letnar1, Klaus Kaae Andersen1, Tom Skyhøj Olsen2
1Omicron ApS, Copenhagen, Denmark.
Objectives:
The extent of triptan use among users of combined hormonal contraceptives (CHC) is unknown. Likewise, it is unclear whether triptan use influences the risk of stroke in CHC users. In a Danish population of CHC users, we examined the prevalence of triptan use and assessed its impact on stroke risk.
Study Design:
In this historical cohort study based on registries covering the Danish female population aged 18-49 years 2004-2021 we investigated incidence rate ratios (IRR) and incidence rate differences (IRD) of ischemic (IS) and hemorrhagic (ICH) stroke in users of CHCs who had been prescribed triptans compared with those without triptan use. Poisson regression models adjusting for age, ethnicity, education, calendar year and risk factors were applied.
Results:
Among 1711,757 women, 982,962 (57%) were CHC users, contributing 4446,000 person-years of CHC use. Of these, 98,399 (10%) had used triptans, contributing 325,000 person-years. CHC users with triptan prescriptions had an increased risk of IS compared to users without prescriptions (IRR 1.60; 95% CI 1.33,1.92); IRD range by age group 2-42/100,000 person-years). Stroke risk was independent of triptan prescription frequency and ethinylestradiol dose. Compared with women who use neither CHCs, other hormonal contraceptives, nor triptans, CHC users with triptan prescriptions had an increased risk of IS (IRR 2.61; 95% CI: 2.21-3.08). Risk was not increased for ICH.
Conclusions:
Among approximately one million Danish CHC users, 10% had been prescribed triptans. In this population the risk of IS was increased 1.60-fold compared with those without triptan use. Triptan use constitutes a risk factor for IS in CHC users. Although the absolute risk is generally low, it is highest among the oldest users.
Implications:
Among approximately one million Danish CHC users, 10% had been prescribed triptans, and in this group the risk of ischemic stroke was 1.60 times higher. Among CHC users with migraine, triptan use should be regarded as a risk factor for ischemic stroke and taken into account when considering CHCs as a contraceptive option.
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