Women who use nonsteroidal anti-inflammatory pain medications along with hormonal contraceptives appear to be at low risk increased risk of blood clots This is called venous thromboembolism (VTE), according to a large Danish study published in The BMJ.
The risk was higher in women taking combined oral contraceptives Third or fourth generation progestogens but lower in those taking progestogen-only tablets, implants and IUDs along with the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen, diclofenac and naproxen.
The researchers emphasize that the absolute risk of developing a serious blood clot is low, even in women using high-risk hormonal contraceptives. However, given the widespread use of both hormonal contraceptives and NSAIDs, they point out this Women should be warned this possible drug interaction.
NSAIDs have previously been linked to the formation of blood clots, but little is known about whether NSAID use affects the risk of venous thromboembolism in otherwise healthy women using hormonal contraceptives.
To address this problem, researchers used the national medical records To track initial venous thromboembolism diagnoses in 2 million women aged 15 to 49 who lived in Denmark between 1996 and 2017 and had no history of blood clots, cancer, hysterectomy or fertility treatment.
Hormonal contraception was categorized into high, intermediate and low risk depending on its association with VTE based on previous studies.
Come on high risk hormonal contraceptives These included combined estrogen-progestin patches, vaginal rings, and pills containing 50 mcg of estrogen or third- or fourth-generation progestin.
Come on Medium risk contraceptives included all other combined oral contraceptives and medroxyprogesterone injections, while progestogen-only tablets, implants and hormonal intrauterine devices (IUDs) were classified from little or no risk.
A number of potentially influential factors were also taken into account, such as age, education level, pregnancy history, previous surgery, high blood pressure and diabetes.
In the study, 529,704 women used NSAIDs while taking hormonal contraceptives. He Ibuprofen was the most commonly used NSAID (60%), followed by diclofenac (20%) and naproxen (6%).
There were such cases during an average follow-up period of 10 years 8,710 venous thromboembolic events (2,715 pulmonary embolisms and 5,995 deep vein thromboses) and 228 (2.6%) women died within 30 days of their diagnosis.
In absolute terms, NSAID use was associated four additional venous thromboembolic events per week per 100,000 women not using hormonal contraceptives, 11 additional episodes in women using intermediate-risk hormonal contraceptives, and 23 additional episodes in women using high-risk hormonal contraceptives.
Among individual NSAIDs, the association was stronger with diclofenac than with ibuprofen and naproxen.
So this is an observational study The cause cannot be determined and the researchers point out several limitations, such as: B. lack of information on smoking and obesity, which they believe may have influenced their results.
However, this is a large study based on high-quality registry data and the researchers were able to consider a variety of potentially influential factors. Furthermore, the associations persisted in subsequent analyses, suggesting that they are robust.
The researchers conclude that “this nationwide study using high-quality, linkable national registries provides new insights into the risk of a life-threatening event from concurrent use of two classes of medications.” is often prescribed to otherwise healthy women“.
And they suggest that “women who require both hormonal contraceptives and regular use of NSAIDs should be counseled accordingly.”
These data suggest important concerns on the simultaneous use of NSAIDs, especially diclofenac, and high-risk hormonal contraceptives, writes Morten Schmidt from Aarhus University Hospital, Denmark, in a linked editorial.
It suggests that health and regulatory authorities consider these results in their assessment of the safety of nonprescription diclofenac and that women using hormonal contraceptives and their physicians consider alternatives to NSAIDs for analgesia.
“If treatment with NSAIDs is necessary, Active ingredients other than diclofenac appear to be preferable together with lower-risk hormonal contraceptives such as progestogen-only tablets, implants or intrauterine devices,” he concludes.
