Recurrence after stopping anticoagulants in women with combined oral contraceptive-associated venous thromboembolism: A systematic review and meta-analysis

Jameel Abdulrehman; Carolyne Elbaz; David Aziz; Sameer Parpia; Rouhi Fazelzad; Lisbeth Eischer; Marc A Rodger; Suzanne C Cannegieter; Arina Ten Cate-Hoek; Michael Nagler; Sam Schulman; Suely M Rezende; Valérie Olié; Gualtiero Palareti; Maura Marcucci; James Douketis; Daniela Poli; Michal Zabczyk; Diana Aguiar de Sousa; Bruno Miranda; Mary Cushman; Alberto Tosetto; Gregoire Le Gal; Clive Kearon; Leslie Skeith

doi:10.1111/bjh.18331

Recurrence after stopping anticoagulants in women with combined oral contraceptive-associated venous thromboembolism: A systematic review and meta-analysis

Br J Haematol. 2022 Oct;199(1):130-142. doi: 10.1111/bjh.18331. Epub 2022 Jul 25.

Authors

Jameel Abdulrehman¹, Carolyne Elbaz², David Aziz³, Sameer Parpia⁴, Rouhi Fazelzad⁵, Lisbeth Eischer⁶, Marc A Rodger², Suzanne C Cannegieter⁷, Arina Ten Cate-Hoek⁸, Michael Nagler⁹, Sam Schulman¹⁰, Suely M Rezende¹¹, Valérie Olié¹², Gualtiero Palareti¹³, Maura Marcucci¹⁴, James Douketis¹⁵, Daniela Poli¹⁶, Michal Zabczyk¹⁷, Diana Aguiar de Sousa¹⁸, Bruno Miranda¹⁹, Mary Cushman²⁰, Alberto Tosetto²¹, Gregoire Le Gal²², Clive Kearon²³, Leslie Skeith²⁴

Affiliations

¹ Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
² Department of Medicine, McGill University, Montreal, Quebec, Canada.
³ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁴ Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
⁵ Library and Information Services, University Health Network (UHN)- Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
⁶ Department of Medicine I, Medical University of Vienna, Vienna, Austria.
⁷ Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
⁸ Thrombosis Expertise Center, Maastricht University Medical Center and Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
⁹ Department of Clinical Chemistry, Inselspital, Bern University Hospital, Bern, Switzerland.
¹⁰ Department of Medicine and Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada.
¹¹ Department of Internal Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
¹² Santé publique France, French national public health agency, Saint-Maurice, France.
¹³ Arianna Anticoagulazione Foundation, Bologna, Italy.
¹⁴ Department of Health Research Methods, Evidence, and Impact, and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
¹⁵ Department of Medicine, St. Joseph's Healthcare Hamilton and McMaster University, Hamilton, Ontario, Canada.
¹⁶ Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
¹⁷ Institute of Cardiology, Jagiellonian University Medical College and John Paul II Hospital, Krakow, Poland.
¹⁸ Hospital de Santa Maria, Lisbon School of Medicine, University of Lisbon, Lisboa, Portugal.
¹⁹ Physiology Institute - Lisbon School of Medicine, University of Lisbon, Lisboa, Portugal.
²⁰ Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA.
²¹ Hemophilia and Thrombosis Center, Hematology Department, S. Bortolo Hospital, Vicenza, Italy.
²² Ottawa Health Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
²³ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
²⁴ Division of Hematology and Hematological Malignancies, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.

PMID: 35877546
DOI: 10.1111/bjh.18331

Abstract

The risk of recurrence after discontinuation of anticoagulation for a combined oral contraceptive (COC)-associated venous thromboembolism (VTE) is unclear. Therefore, we conducted a systematic review and meta-analysis to estimate the incidence of recurrent VTE among women with COC-associated VTE, unprovoked VTE and to compare the incidence of recurrent VTE between the two groups. The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase Classic +Embase and Medline ALL to July 2020 and citations from included studies were searched. Randomized controlled trials, prospective cohort studies and meta-analyses of these study types were selected. The analysis was conducted by random-effects model. Nineteen studies were identified including 1537 women [5828 person-years (PY)] with COC-associated VTE and 1974 women (7798 PY) with unprovoked VTE. Studies were at low risk of bias. The incidence rate of VTE recurrence was 1.22/100 PY [95% confidence interval (CI) 0.92-1.62, I² = 6%] in women with COC-associated VTE, 3.89/100 PY (95% CI 2.93-5.17, I² = 74%) in women with unprovoked VTE and the unadjusted incidence rate ratio was 0.34 (95% CI 0.26-0.46, I² = 3%). The recurrence risk in women after COC-associated VTE is low and lower than after an unprovoked VTE.

Keywords: contraceptive agents; oestrogens; oral contraceptive; recurrence; venous thromboembolism; venous thrombosis; women.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Anticoagulants / adverse effects
Contraceptives, Oral, Combined / adverse effects
Female
Humans
Prospective Studies
Recurrence
Risk Factors
Venous Thromboembolism* / epidemiology
Venous Thromboembolism* / etiology

Substances

Anticoagulants
Contraceptives, Oral, Combined