Oral Contraceptive Use Is Associated With an Increased Risk of Venous Thromboembolism After Lower-Extremity but Not...

Oral contraceptive pills (OCPs) are widely used among premenopausal women and have been associated with an increased risk of venous thromboembolism (VTE) due to the prothrombotic effects of estrogen. Although arthroscopic procedures generally carry low postoperative VTE risk, it remains unclear whether OCP use differentially influences thromboembolic complications following upper- and lower-extremity arthroscopic procedures.

This study used the TriNetX Research Network to query women aged 14-40 who underwent arthroscopic shoulder/elbow or hip/knee/ankle procedures between 2010 and 2025. Patients prescribed OCPs within six months preoperatively to three months postoperatively were compared with those not prescribed OCPs. Exclusion criteria included thrombophilia, prior VTE, hormone replacement therapy, pregnancy, and trauma. Propensity score matching was performed in a 1:1 ratio on demographic and comorbidity variables. Outcomes assessed within 90 days postoperatively included VTE, deep vein thrombosis (DVT), pulmonary embolism (PE), readmission, emergency department (ED) visits, and infection.  Results: After propensity score matching, 1,217 patients were included in each upper-extremity cohort and 6,438 patients in each lower-extremity cohort. In the upper-extremity group, OCP use was not associated with an increased risk of VTE (RR: 1.200; 95% CI: 0.520-2.767; p = 0.830), DVT (RR: 1.000; 95% CI: 0.418-2.394; p = 1.000), PE, readmission, ED visits, or infection. In the lower-extremity group, OCP users had a significantly higher risk of VTE (RR: 1.756; 95% CI: 1.199-2.573; p = 0.005) and DVT (RR: 1.714; 95% CI: 1.132-2.597; p = 0.013), but no differences in PE (RR: 1.900; 95% CI: 0.884-4.083; p = 0.137), readmission, ED visits, or infection.  Conclusion: In this retrospective propensity-matched database study, OCP use was associated with an increased risk of postoperative VTE and DVT following lower-extremity arthroscopic procedures, but not upper-extremity procedures. These findings should be interpreted in the context of procedural heterogeneity and unavailable perioperative factors, including thromboprophylaxis and postoperative mobilization. Future procedure-specific studies are warranted to better define individualized perioperative VTE risk.