Presentation Outline ICHP Annual Meeting September 13-15

Hormonal Contraception and VTE
• Attributed to
– Estrogens
• ethinyl estradiol
• Induction of hepatic procoagulant proteins
• Sex hormone‐binding globulins
– Newer generation progestins
• desogestrel, norgestimate, drospirenone
• Effect on coagulation and fibrinolytic pathways
• Resistance to activated protein C
Pharmacists’ Letter/Prescriber’s Letter. August 2012: #280804.
Hormonal Contraception and
Thrombosis
• FDA study (n=835,826)
– Compared thrombosis rates between newer and older
combined contraceptives
– VTE risk increased with ring ring, patch patch, and drospirenone
compared to older combined contraceptives
• Denmark study ‐ VTE (n=1,626,158)
– Compared VTE rates between nonoral users to nonusers
– Risk increased with vaginal ring and transdermal patch
BMJ. 2012;344:e2990.
http://www.fda.gov/downloads/Drugs/DrugSafety/UCM277384.pdf.
Stroke, MI, and
Hormonal Contraception
• Study objective
– To assess the risks of thrombotic stroke and MI
associated with various types of hormonal
contraception, p , according g to estrogen g dose, ,
progestin type, and route of administration.
• Methods
– Historical cohort study
N Engl J Med. 2012;366(24):2257-2266.
8/30/2012
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