Girls who use some kinds of hormonal contraception and customary painkillers known as nonsteroidal anti-inflammatory medicine (NSAIDs) on the identical time might have a barely elevated threat of creating blood clots, new analysis suggests.
In an observational examine of two million ladies in Denmark printed Wednesday (Sept. 6) within the journal The BMJ, researchers discovered that those that used NSAIDs similtaneously hormonal contraception had an elevated threat of creating blood clots of their veins, a probably disabling or lethal situation often called venous thromboembolism (VTE). NSAIDs embrace medicine like ibuprofen, naproxen and diclofenac.
The examine authors emphasised that, even amongst ladies utilizing the highest-risk contraception choice studied, absolutely the threat of VTE they noticed was nonetheless comparatively low — round 0.02% of girls within the highest-risk class. Nonetheless, they are saying the findings might assist inform well being care suppliers who’re advising sufferers on which medicine could also be best suited for them.
“Contemplating the thousands and thousands of girls uncovered to those drug courses, it’s in fact of curiosity, in a public well being matter, to cut back the danger of thrombosis [blood clots] in concomitant customers of those two drug courses,” Dr. Amani Meaidi, lead creator of the examine and a postdoctoral researcher on the College of Copenhagen, advised Reside Science in an e-mail.
In previous research, hormonal contraceptives and NSAIDs have individually been linked to an elevated threat of creating VTE. Nevertheless, there was little analysis into whether or not utilizing each on the identical time might exacerbate this threat.
Within the new examine, researchers seemed on the medical data of 15- to 49-year-old ladies dwelling in Denmark between 1996 and 2017 who had by no means had a blood clot, most cancers, infertility therapy or surgical procedure to have their uterus eliminated. They tracked individuals’s prescriptions for hormonal contraception and NSAIDs utilizing Denmark’s Nationwide Registry of Medicinal Product Statistics. In all, greater than 529,000 ladies used hormonal contraception and NSAIDs on the identical time, with the commonest NSAIDs being ibuprofen, diclofenac and naproxen.
The group categorized various kinds of hormonal contraception into threat ranges primarily based on earlier research that investigated the danger of blood clots in individuals who took them. “Excessive-risk” contraceptives included mixed estrogen and progestin patches, vaginal rings, and drugs containing 50 micrograms of estrogen. Mixed oral contraceptives and medroxyprogesterone injections (Depo-Provera) had been deemed “medium threat,” and progestin-only tablets (typically known as “minipills”), implants and hormonal IUDs had been thought-about “low” or “no threat.”
They discovered that utilizing NSAIDs alone was linked to a barely elevated threat of blood clots, and that the danger was considerably amplified when a medium-to high-risk hormonal contraceptive was added.
The mixed threat is larger in ladies who additionally used high-risk contraception than in those that used medium- or low-risk varieties. For ladies who did not use hormonal contraception, for each 100,000 who used an NSAID for every week, the group estimated that an additional 4 would develop a blood clot than in the event that they did not use NSAIDs. This quantity stays about the identical for girls utilizing NSAIDs with low-risk contraceptives, however it jumps to 11 for these utilizing medium-risk choices and to 23 for girls on high-risk contraceptives.
“This probably suggests a synergistic drug interplay between these two drug courses,” Meaidi stated. Nevertheless, within the paper, her and her co-authors notice that “additional analysis is warranted to find out the potential existence and mechanism of such drug interplay.”
The examine authors did spotlight a number of limitations of the analysis. For example, they’re lacking data on smoking and weight problems charges amongst these studied, which can have affected the findings. Nor did they take into account race or ethnicity, which may affect somebody’s threat of creating blood clots.
Additionally, as a result of this was an observational examine, it doesn’t present that both drug class, alone or mixed, immediately causes blood clots.
Dr. Andrew Kaunitz, a professor of obstetrics and gynecology on the College of Florida who was not concerned within the analysis, additionally stated it was potential that a difficulty known as protopathic bias might clarify the findings. This time period describes when a drug is prescribed to deal with the preliminary signs of a illness that hasn’t but been recognized.
“Use of NSAIDs by reproductive age ladies may mirror early (not but recognized) situations, resembling lupus or rheumatoid arthritis, situations which themselves are related to an elevated threat of clot,” Kaunitz advised Reside Science in an e-mail.
When contemplating the danger of blood clots tied to hormonal contraception, Kaunitz stated it is essential to maintain that threat in context. “You will need to remember the fact that the situation which contraception prevents, notably being pregnant, is related to a a lot larger threat of blood clot than any contraceptive,” he stated.