title: Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis.
abstract: OBJECTIVE
  To provide a comprehensive overview of the risk of venous thrombosis in women using different combined oral contraceptives.
  
  
  METHODS
  Systematic review and network meta-analysis.
  
  
  METHODS
  PubMed, Embase, Web of Science, Cochrane, Cumulative Index to Nursing and Allied Health Literature, Academic Search Premier, and ScienceDirect up to 22 April 2013.
  
  
  METHODS
  Observational studies that assessed the effect of combined oral contraceptives on venous thrombosis in healthy women. The primary outcome of interest was a fatal or non-fatal first event of venous thrombosis with the main focus on deep venous thrombosis or pulmonary embolism. Publications with at least 10 events in total were eligible. The network meta-analysis was performed using an extension of frequentist random effects models for mixed multiple treatment comparisons. Unadjusted relative risks with 95% confidence intervals were reported. The requirement for crude numbers did not allow adjustment for potential confounding variables.
  
  
  RESULTS
  3110 publications were retrieved through a search strategy; 25 publications reporting on 26 studies were included. Incidence of venous thrombosis in non-users from two included cohorts was 1.9 and 3.7 per 10,000 woman years, in line with previously reported incidences of 1-6 per 10,000 woman years. Use of combined oral contraceptives increased the risk of venous thrombosis compared with non-use (relative risk 3.5, 95% confidence interval 2.9 to 4.3). The relative risk of venous thrombosis for combined oral contraceptives with 30-35 µg ethinylestradiol and gestodene, desogestrel, cyproterone acetate, or drospirenone were similar and about 50-80% higher than for combined oral contraceptives with levonorgestrel. A dose related effect of ethinylestradiol was observed for gestodene, desogestrel, and levonorgestrel, with higher doses being associated with higher thrombosis risk.
  
  
  CONCLUSIONS
  All combined oral contraceptives investigated in this analysis were associated with an increased risk of venous thrombosis. The effect size depended both on the progestogen used and the dose of ethinylestradiol.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, UK.
authors.forename: Bernardine H
authors.initials: BH
authors.lastname: Stegeman
authors.forename: Marcos
authors.initials: M
authors.lastname: de Bastos
authors.forename: Frits R
authors.initials: FR
authors.lastname: Rosendaal
authors.forename: A
authors.initials: A
authors.lastname: van Hylckama Vlieg
authors.forename: Frans M
authors.initials: FM
authors.lastname: Helmerhorst
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.forename: Olaf M
authors.initials: OM
authors.lastname: Dekkers
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004997:Ethinyl Estradiol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D011372:Progestins / Q000008:administration & dosage* / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D020246:Venous Thrombosis / Q000139:chemically induced* / Q000453:epidemiology*; D016903:Drug Monitoring
chemical_list: D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D011372:Progestins; D004997:Ethinyl Estradiol
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