NSAID Use May Increase VTE Risk Among Women Using Hormonal Contraception

A new study published in the BMJ suggests that NSAID use may increase VTE risk among women using hormonal contraception.

Study Overview

A study was conducted to understand the influence of concomitant use of hormonal contraception and non-steroidal anti-inflammatory drugs (NSAIDs) on the risk of venous thromboembolism. The study included all 15-49 year old women living in Denmark between 1996 and 2017 with no medical history of any venous or arterial thrombotic event, cancer, thrombophilia, hysterectomy, bilateral oophorectomy, sterilisation, or infertility treatment (n=2,029,065).

Results

Among 2.0 million women followed for 21.0 million person years, 8,710 venous thromboembolic events occurred. Compared with non-use of NSAIDs, use of NSAIDs was associated with an adjusted incidence rate ratio of venous thromboembolism of:

• 7.2 (95% confidence interval 6.0 to 8.5) in women not using hormonal contraception
• 11.0 (9.6 to 12.6) in women using high risk hormonal contraception
• 7.9 (5.9 to 10.6) in those using medium risk hormonal contraception
• 4.5 (2.6 to 8.1) in users of low/no risk hormonal contraception

The corresponding numbers of extra venous thromboembolic events per 100,000 women over the first week of NSAID treatment compared with non-use of NSAIDs were:

• 4 (3 to 5) in women not using hormonal contraception
• 23 (19 to 27) in women using high risk hormonal contraception
• 11 (7 to 15) in those using medium risk hormonal contraception
• 3 (0 to 5) in users of low/no risk hormonal contraception

NSAID use was positively associated with the development of venous thromboembolism in women of reproductive age. The number of extra venous thromboembolic events with NSAID use compared with non-use was significantly larger with concomitant use of high/medium risk hormonal contraception compared with concomitant use of low/no risk hormonal contraception. Women needing both hormonal contraception and regular use of NSAIDs should be advised accordingly.

Reference

Meaidi A, Mascolo A, Sessa M, Toft-Petersen AP, Skals R, Gerds TA, Wessel Skovlund C, Morch LS, Rossi F, Capuano A, Lidegaard O, Torp-Pedersen C. Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study. BMJ. 2023 Sep 6;382:e074450. doi: 10.1136/bmj-2022-074450. PMID: 37673431; PMCID: PMC10480689.

Keywords

NSAID use, VTE risk, hormonal contraception, Meaidi A, Mascolo A, Sessa M, Toft-Petersen AP, Skals R, Gerds TA, Wessel Skovlund C, Morch LS, Rossi F, Capuano A, Lidegaard O, Torp-Pedersen C, BMJ