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mercredi 16 mars 2016

Prescribing oral contraceptives in obese women is very dangerous

"The study included 186 cases and 6134 controls. Cases were younger (median age, 40 vs 48 years), more often female (133 [71.5%] vs 3220 [52.5%]), more often used oral contraceptives (97 [72.9%] vs 758 [23.5%] of women), and more frequently had a history of cancer (17 [9.1%] vs 235 [3.8%]) compared with controls. Obesity (BMI ≥30) was associated with an increased risk of CVT (adjusted odds ratio [OR], 2.63; 95% CI, 1.53-4.54). Stratification by sex revealed a strong association between CVT and obesity in women (adjusted OR, 3.50; 95% CI, 2.00-6.14) but not in men (adjusted OR, 1.16; 95% CI, 0.25-5.30). Further stratification revealed that, in women who used oral contraceptives, overweight and obesity were associated with an increased risk of CVT in a dose-dependent manner (BMI 25.0-29.9: adjusted OR, 11.87; 95% CI, 5.94-23.74; BMI ≥30: adjusted OR, 29.26; 95% CI, 13.47-63.60). No association was found in women who did not use oral contraceptives."
http://archneur.jamanetwork.com/article.aspx?articleid=2500277

In this case-control study that included 186 cases and 6134 controls, obesity was associated with a statistically significant 3-fold increased risk of cerebral venous thrombosis. Stratification by sex revealed that in women who used oral contraceptives, the risk was increased 30-fold. In contrast, we found no association in men or women who did not use oral contraceptives.
Despite those alarming relative risks increases the absolute odd is low however.
This paper is awsome: http://onlinelibrary.wiley.com/doi/10.1111/jth.12266/full




















































Table 1. Overview of differential relative risks of a first VTE for various hormonal contraceptives and HRT


Hormonal contraceptives

Absolute risk (per 1000 person-years)*





HRT, hormone replacement therapy; VTE, venous thromboembolism. *Estimates of the absolute risk were obtained by multiplying the odds ratio with the baseline incidence of VTE of 0.39 per 1000 person-years for women aged 20–44 for hormonal contraceptives, and of 1.00 per 1000 person-years for women aged 45–54 for HRT [3]. †Ethinylestradiol in the most commonly used dose of 30–40 mcg daily. ‡Upper limits of the 95% CIs (10.7 for noresthisterone and 7.1 for injectable depot medroxyprogesterone) do not exclude a strong risk increase. §Inconsistent results from no increased to an increased risk of VTE as compared to oral contraceptives containing norgestimate; no data available of patch users vs. non-users. ¶Upper limit of the 95% CI (3.4) does not exclude a risk increase. **Data from SAE reporting in clinical outcome studies. Wide confidence intervals do not exclude a modest or strong risk increase. ††Upper limit of the 95% CI (1.7) does not exclude a modest risk increase.


Strong risk increase (odds ratio 5–8) [7, 105-107]


Ethinylestradiol†/desogestrel

2.8 (2.1–3.9)


Ethinylestradiol†/cyproterone

2.7 (1.8–3.9)


Ethinylestradiol†/drosperidone

2.5 (1.1–5.3)


Ethinylestradiol†/norgestimate

2.3 (0.7–8.2)


Ethinylestradiol†/gestodene

2.2 (1.4–3.3)


Ethinylestradiol†/lynestrenol

2.2 (1.2–4.0)


Oral progestagen only, high dose (5–30 mg)

2.1 (0.6–7.3)


Moderate risk increase (odds ratio 2–5) [7, 108]


Ethinylestradiol†/noresthisterone‡

1.5 (0.5–4.1)


Ethinylestradiol†/levonorgestrel

1.4 (1.1–1.8)


Injectable depot medroxyprogesterone‡

1.4 (0.7–2.8)


Transdermal ethinylestradiol/norelgestromin§

1.5 (0.5–4.1)


No risk increase [12, 109, 110]


Levonorgestrel releasing IUD

0.1 (0.0–0.4)


Progestagen only, low-dose norethisteron 350 μg or levonorgestrel 30 μg

0.2 (0.1–0.4)


Progestagen only, low-dose desogestrel 75 μg¶

0.2 (0.1–0.7)


Uncertain [111]**


Etonogestrel subcutaneous implant

0.5 (0.01–2.9)


Vaginal ring (ethinylestradiol/etonogestrel)

1.5 (0.1–5.4)


HRT


Moderate risk increase (OR 1.5–3.0) [11, 112]


Oral combined estrogen/progestagen pills

2.6 (2.0–3.2)


Oral estrogen only

2.2 (1.6–3.0)


No risk increase [11, 112]


Transdermal (combined estrogen/progestagen and estrogen only) ††

1.2 (0.9–1.7)


Tibolone

0.9 (0.8–1.1)

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