title: Thromboembolic events in women exposed to hormonal contraception or cyproterone acetate in 2012: a cross-sectional observational study in 30 French public hospitals.
abstract: BACKGROUND
  In the context of the European reassessment of the benefit-risk balance of hormonal contraceptives, French data about thromboembolic events were requested.
  
  
  OBJECTIVE
  The aim of this study was to determine the number of patients exposed to hormonal contraception or cyproterone acetate among hospitalized females diagnosed with a thromboembolic event in 2012, to retrospectively analyze specific risk factors of venous and arterial thromboembolism and to assess the magnitude of the under-reporting of such events to the national pharmacovigilance system.
  
  
  METHODS
  This cross-sectional study included 15- to 49-year-old women with pulmonary embolism, venous cerebral thrombosis, ischemic stroke, or myocardial infarction, hospitalized in 2012, and identified within the computerized hospital databases of 30 French teaching hospitals.
  
  
  RESULTS
  Among the 2,966 cases identified, 803 (27.1 %) patients had been exposed to a hormonal contraceptive (747) or to cyproterone acetate (56). Among these, there were 452 venous thromboembolic events (VTEs) and 351 arterial thromboembolic events (ATEs). Age ≥40 years and personal thrombophilia diagnosed after the event were the main VTE risk factors, while current smoking and age ≥40 years were the main ATE risk factors. The mean number of associated risk factors was significantly lower for VTE than for ATE (1.1 vs 2.3). The proportion of cases with no risk factors was higher for third- and fourth-generation than for first- and second-generation combined oral contraceptives. Overall, the under-reporting rate was 92.5 % (95 % CI 70.0-97.3).
  
  
  CONCLUSIONS
  This study highlighted the need to strengthen the knowledge of patients and health professionals about thromboembolic risk factors at the first prescription and renewal of hormonal contraceptives.
authors.affiliation: Regional Pharmacovigilance Centre, University Hospital, 69424, Lyon, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Gourbil
authors.forename: Aurélie
authors.initials: A
authors.lastname: Grandvuillemin
authors.forename: Marie-Noëlle
authors.initials: MN
authors.lastname: Beyens
authors.forename: Nathalie
authors.initials: N
authors.lastname: Massy
authors.forename: Valérie
authors.initials: V
authors.lastname: Gras
authors.forename: Andréa
authors.initials: A
authors.lastname: D'Amico
authors.forename: Ghada
authors.initials: G
authors.lastname: Miremont-Salamé
authors.forename: Nadine
authors.initials: N
authors.lastname: Petitpain
mesh_terms: D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D017373:Cyproterone Acetate / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000209:etiology*; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000139:chemically induced* / Q000209:etiology*; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal; D017373:Cyproterone Acetate