A new study has found that women using NSAIDs with hormonal contraceptives, especially high-risk types and those using diclofenac, have an increased risk of blood clots. This study calls for increased awareness and careful consideration of safer pain relief and contraceptive options.
Researchers advise that while the absolute risk remains low, women should be informed accordingly.
People using nonsteroidal anti-inflammatory painkillers in combination with hormonal contraceptives may be at a slightly higher risk of venous thromboembolism (VTE), according to a recently published comprehensive Danish study. There is a gender. BMJ.
The risk was higher for women using combination oral contraceptives containing third- or fourth-generation progestins, but the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen, diclofenac, and progestin-only tablets; Women with implants and coils had a smaller risk. Naproxen.
Researchers stress that the absolute risk of developing serious blood clots is low, even for women using high-risk hormonal contraceptive methods. However, they say that given the widespread use of both hormonal contraceptives and NSAIDs, women should be informed of this potential drug interaction in a timely manner.
Classification of hormonal contraception and NSAID use
Although NSAIDs have been linked to blood clots, little is known about whether their use affects the risk of venous thromboembolism in healthy women using hormonal contraceptives. not.
To address this, the researchers used national medical records to find 49 children aged 15 to 49 with no history of blood clots, cancer, hysterectomy, or infertility treatment living in Denmark between 1996 and 2017. Two million women aged 20-30 years were tracked for their first diagnosis of venous thromboembolism.
Hormonal contraception was classified as high-risk, intermediate-risk, and low-risk according to its association with VTE based on previous studies.
High-risk hormonal contraception includes patches that combine estrogen and progestin, vaginal rings, and tablets containing 50 mcg of estrogen or third- or fourth-generation progestins. Moderate-risk contraception includes all other combination oral contraceptives and medroxyprogesterone injections, but progestin-only pills, implants, and hormonal intrauterine devices (coils) are classified as low-risk or no risk. I did.
Various potentially influencing factors were also taken into account, including age, education level, pregnancy history, previous surgical history, hypertension, and diabetes.
In this study, 529,704 women using hormonal contraceptives used NSAIDs. The most frequently used NSAID was ibuprofen (60%), followed by diclofenac (20%) and naproxen (6%).
Over an average 10-year monitoring period, 8,710 cases of venous thromboembolism (2,715 pulmonary embolisms and 5,995 deep vein thromboses) occurred, and 228 (2.6%) women died within 30 days of diagnosis.
Meaning and recommendations
In absolute terms, NSAID use is associated with 4 additional venous thromboembolic events per week per 100,000 women not using hormonal contraception and using intermediate-risk hormonal contraception. It was associated with 11 additional events in women and 23 additional events in women using high-risk hormonal contraception.
Among individual NSAIDs, diclofenac had the strongest association compared with ibuprofen and naproxen.
Because this is an observational study, it is not possible to determine cause, and the researchers highlight several limitations, such as missing information on smoking and obesity, which may influence the results. It is said that there is a possibility that
Nevertheless, this was a large study based on high-quality registry data, allowing the researchers to adjust for a wide range of potentially influencing factors. Furthermore, the associations persisted after further analysis, suggesting that they are robust.
Therefore, the researchers concluded that: “By using high-quality, linkable national registries, this national study shows that potentially fatal events occur when two drugs commonly prescribed to healthy women are taken together. It adds new knowledge about the risks involved.”
They added: “Women who require both hormonal contraception and regular use of NSAIDs should be advised accordingly.”
These data raise important concerns about the combined use of NSAIDs, particularly diclofenac, and high-risk hormonal contraceptives, writes Morten Schmidt. Aarhus University Hospital, linked editorial.
She said health authorities and regulators should include these findings in safety assessments of over-the-counter diclofenac, and that women using hormonal contraceptives and their clinicians should consider alternatives to NSAIDs for pain relief. I suggest that you should.
“If treatment with an NSAID is necessary, it may be preferable to use drugs other than diclofenac in conjunction with low-risk hormonal contraceptives, such as progestin-only tablets, implants, or intrauterine devices.” He concludes.
This study was funded by the Danish Heart Foundation.
