NSAID use compounds venous thromboembolic risk with high-risk hormonal contraception
Click Here to Manage Email Alerts
Key takeaways:
- NSAID use increased venous thromboembolism risk for women using hormonal contraception.
- NSAID agents other than diclofenac are preferred along with lower-risk hormonal contraceptives for countering VTE risk.
Use of NSAIDs significantly increased risk for venous thromboembolism when used concomitantly with hormonal contraception already associated with medium/high risk vs. low/no-risk, according to study results published in The BMJ.
“Although both hormonal contraceptives and NSAIDs contain active ingredients that may affect blood coagulability, how concomitant use of the two drug classes affects the risk of development of venous thromboembolism in women of reproductive age remains to be explored,” Amani Meaidi, MD, physician and postdoctoral researcher in the department of gynecology and the department of clinical medicine at the University of Copenhagen, Denmark, and colleagues wrote. “Considering the worldwide prevalent use of these drugs and the severity of venous thromboembolic disease, this is an important public health matter.”
Meaidi and colleagues conducted a nationwide cohort study analyzing data from 2,029,065 women aged 15 to 49 years who lived in Denmark between 1996 and 2017. All women had no history of venous or arterial thrombotic events, cancer, thrombophilia, hysterectomy, bilateral oophorectomy, sterilization or infertility treatment.
The primary outcome was a first-time hospital discharge diagnosis of lower-limb deep venous thrombosis or pulmonary embolism.
Overall, 8,710 venous thromboembolic events occurred throughout 21 million person-years. NSAID use was associated with venous thromboembolism development among women not using hormonal contraception (adjusted incidence rate ratio [aIRR] = 7.2; 95% CI, 6-8.5), and women using high-risk hormonal contraception (aIRR = 11; 95% CI, 9.6-12.6), medium-risk hormonal contraception (aIRR = 7.9; 95% CI, 5.9-10.6) and low/no-risk hormonal contraception (aIRR = 4.5; 95% CI, 2.6-8.1).
Over the first week of NSAID treatment, the corresponding numbers of extra venous thromboembolic events per 100,000 women were four among those not using hormonal contraception, 23 among those using high-risk hormonal contraception, 11 among those using medium-risk hormonal contraception and three among those using low/no-risk hormonal contraception.
“Considering the highly prevalent indications for use of hormonal contraception and of NSAIDs, studying this association further would be of public interest, especially in regular users of NSAIDs, who might benefit from a low/no risk hormonal contraceptive rather than a high/medium risk hormonal contraceptive,” the researchers wrote.
In an accompanying editorial, Morten Schmidt, MD, associate professor in the department of clinical epidemiology at Aarhus University Hospital, Denmark, noted that these data raise important concerns about using NSAIDs, particularly the agent diclofenac, concomitantly with high-risk hormonal contraception.
“Health care authorities and regulators should include these findings in their safety assessment of available over-the-counter diclofenac, and women using hormonal contraception and their clinicians should consider alternatives to NSAIDs for analgesia,” Schmidt wrote. “If treatment with NSAIDs is needed, agents other than diclofenac seem preferable, along with lower risk hormonal contraceptives, such as progestin only tablets, implants or intrauterine devices.”