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Lower clot risk with levonorgestrel

05 May 2011

By Christian Duffin

Two new studies have added to evidence that some types of contraceptive pill carry a higher risk of serious blood clots than others.

Pills containing the progestogen hormone drospirenone are associated with three times the level of risk of venous thromboembolism than pills containing levonorgestrel, the research suggests.

One study, based on US medical claims data, found a two-fold increased risk of a non-fatal venous thromboembolism in women using drospirenone-containing oral contraceptives compared with women using levonorgestrel-containing oral contraceptives.

The second study used statistics from the UK General Practice Research Database. It found a three-fold increased risk of a first non-fatal venous thromboembolism in women using drospirenone-containing oral contraceptives compared with women using levonorgestrel-containing oral contraceptives.

Professor Susan Jick, professor of epidemiology from Boston University, who was involved in both studies, said: 'Prescribing lower-risk levonorgestrel preparations as the first-line choice in women wishing to take an oral contraceptive would seem prudent.'

BMJ 2011; 342: 2451 and BMJ 2011; 342: 2139

Lower clot risk with levonorgestrel

READERS' COMMENTS

Anonymous,
05 May 2011
I am extremely disappointed that the BMJ has been prepared to publish studies which are as seriously flawed as these (and have since published another flawed study on HMB management)

Many GPs read the BMJ and read the headline but not the detail and will not read the rapid response written by the 2 leading national experts who feel these studies are methodologically flawed.

The methodologically sound large prospective study published by Dinger et al in 2007 found no difference in thromboembolic risk between pills containing different progestogens including those containing drosperinone.

25% of women chose combined oral contraception as their favoured method. 25-40% of these abandon the method during the first year because of adverse events or other concerns, without letting their prescriber know, and opt for less reliable methods such as condoms or withdrawal.

If we are going to continue to reduce the numbers of unwanted pregnancies in the UK we need to have the flexibility about prescribing to get the right product for the right woman at the right time, using the UKMEC as our safety manual. Levonorgestrel containing pills do not suit all women so before removing other progestogen containing pills from our formularies we need to make sure that the evidence supporting these decisions is founded and not be influenced by another ill-founded �pill-scare�.
Anne Connolly
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