title: Drospirenone-containing oral contraceptive pills and the risk of venous and arterial thrombosis: a systematic review.
abstract: BACKGROUND
  Previous studies have provided conflicting results regarding the effect of drospirenone-containing oral contraceptive pills (OCPs) on the risk of venous and arterial thrombosis.
  
  
  OBJECTIVE
  To conduct a systematic review to assess the risk of venous thromboembolism (VTE), myocardial infarction (MI), and stroke in individuals taking drospirenone-containing OCPs.
  
  
  METHODS
  We systematically searched CINAHL, the Cochrane Library, Dissertation & Abstracts, EMBASE, HealthStar, Medline, and the Science Citation Index from inception to November 2012.
  
  
  METHODS
  We included all case reports, observational studies, and experimental studies assessing the risk of venous and arterial thrombosis of drospirenone-containing OCPs.
  
  
  METHODS
  Data were collected independently by two reviewers.
  
  
  RESULTS
  A total of 22 studies [six case reports, three case series (including 26 cases), and 13 comparative studies] were included in our systematic review. The 32 identified cases suggest a possible link between drospirenone-containing OCPs and venous and arterial thrombosis. Incidence rates of VTE among drospirenone-containing OCP users ranged from 23.0 to 136.7 per 100 000 woman-years, whereas those among levonorgestrel-containing OCP users ranged from 6.64 to 92.1 per 100 000 woman-years. The rate ratio for VTE among drospirenone-containing OCP users ranged from 4.0 to 6.3 compared with non-users of OCPs, and from 1.0 to 3.3 compared with levonorgestrel-containing OCP users. The arterial effects of drospirenone-containing OCPs were inconclusive.
  
  
  CONCLUSIONS
  Our systematic review suggests that drospirenone-containing OCP use is associated with a higher risk for VTE than both no OCP use and levonorgestrel-containing OCP use.
authors.affiliation: Faculty of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: C Q
authors.initials: CQ
authors.lastname: Wu
authors.forename: S M
authors.initials: SM
authors.lastname: Grandi
authors.forename: K B
authors.initials: KB
authors.lastname: Filion
authors.forename: H A
authors.initials: HA
authors.lastname: Abenhaim
authors.forename: L
authors.initials: L
authors.lastname: Joseph
authors.forename: M J
authors.initials: MJ
authors.lastname: Eisenberg
mesh_terms: D000736:Androstenes / Q000009:adverse effects*; D001158:Arteries; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D009203:Myocardial Infarction / Q000139:chemically induced*; D011655:Pulmonary Embolism / Q000139:chemically induced*; D012306:Risk; D020521:Stroke / Q000139:chemically induced*; D013927:Thrombosis / Q000139:chemically induced*; D054556:Venous Thromboembolism / Q000139:chemically induced; D020246:Venous Thrombosis / Q000139:chemically induced
chemical_list: D000736:Androstenes; D003278:Contraceptives, Oral, Hormonal; C035144:drospirenone