Abstract
Background
Combined oral contraceptives (COC) increase the risk of venous thromboembolism (VTE),
but the risk of recurrent VTE is not precisely determined. In this retrospective cohort
study, we sought the risk factors for recurrence after a first VTE that occurred in
women taking COC.
Study Design
Time-to-event analysis was done with Kaplan���Meier estimates. In total, 172 patients
were included (43% with pulmonary embolism): 82% had no other clinical risk factor
for VTE.
Results
Among the 160 patients who stopped anticoagulation, the cumulative incidence of recurrent
VTE was 5.1% after 1 year and 14.2% after 5 years. Significant factors associated
with recurrence were renewed use of COC [hazard ratio (HR)=8.2 (2.1���32.2)], antiphospholipid
syndrome [HR=4.1 (1.3���12.5)] and protein C deficiency or factor II G20210A [HR=2.7
(1.1���7)]. Pure-progestin contraception [HR=1.3 (0.5���3.0)] or factor V Leiden [HR=1.3
(0.5-3.4)] did not increase recurrence. Postsurgical VTE had a lower risk of recurrence
[HR=0.1 (0.0���0.9)].
Conclusion
Further studies are warranted to determine whether testing for antiphospholipid syndrome,
protein C deficiency or the factor II G20210A could modify the duration of anticoagulation.
This study confirms the safety of pure-progestin contraception.
Keywords
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Article info
Publication history
Published online: August 05, 2011
Accepted:
June 22,
2011
Received in revised form:
June 19,
2011
Received:
March 16,
2011
Footnotes
���This work was supported by public funds (Centre Hospitalier de Clermont-Ferrand, Facult�� de M��decine, Universit�� de Clermont-Ferrand 1).
������Conflict-of-interest disclosure: The authors declare no competing financial interests.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
