title: Association of venous thromboembolism with hormonal contraception and thrombophilic genotypes.
abstract: OBJECTIVE
  To investigate associations between combined hormonal contraception and progestogen-only contraception and risks of venous thromboembolism by progestogen and carriership of genetic hemostatic variations.
  
  
  METHODS
  This was a case-control study in Sweden carried out between 2003 and 2009, which included 948 patients with venous thromboembolism and 902 individuals in a control group, all aged 18-54 years. Information was obtained by telephone interviews and DNA analyses of blood samples. Radiologic referrals were used for case ascertainment. For comparisons, odds ratios were estimated by unconditional logistic regression analysis adjusting for smoking, body mass index (BMI), and immobilization.
  
  
  RESULTS
  The odds ratio (OR) for current use of combined hormonal contraception was 5.3 (95% confidence interval [CI] 4.0-7.0). Desogestrel combinations had the highest OR (11.4, 95% CI 6.0-22.0). The OR for injection of medroxyprogesterone acetate was 2.2 (95% CI 1.3-4.0). In users of combined hormonal contraception with the factor V Leiden mutation, the OR was 20.6 (95% CI 8.9-58). In women who used progestogen-only contraception and carried the factor V Leiden mutation, the OR was 5.4 (95% CI 2.5-13).
  
  
  CONCLUSIONS
  Risks of venous thromboembolism in association with combined hormonal contraception vary by type of progestogen and independently of BMI and smoking. Thrombophilic genotypes such as factor V Leiden increase risks of venous thromboembolism in users of combined hormonal contraception. Except for injection of medroxyprogesterone acetate, progestin-only contraception seems to be the least thrombogenic hormonal contraception for women carrying genetic hemostatic variations.
  
  
  METHODS
  II.
authors.affiliation: Department of Medicine, Karolinska Institutet, the Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, the Coagulation Unit, Hematology Centre, and the Division of Clinical Pharmacology, Karolinska University Hospital, Stockholm, the Medical Products Agency, Uppsala, and the Department of Clinical Sciences/Medical Radiology, Diagnostic Centre of Imaging and Functional Medicine, Lund University, Lund, Sweden; and the Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Annica
authors.initials: A
authors.lastname: Bergendal
authors.forename: Ingemar
authors.initials: I
authors.lastname: Persson
authors.forename: Jacob
authors.initials: J
authors.lastname: Odeberg
authors.forename: Anders
authors.initials: A
authors.lastname: Sundström
authors.forename: Margareta
authors.initials: M
authors.lastname: Holmström
authors.forename: Sam
authors.initials: S
authors.lastname: Schulman
authors.forename: Ola
authors.initials: O
authors.lastname: Björgell
authors.forename: Helle
authors.initials: H
authors.lastname: Kieler
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003267:Contraception / Q000379:methods; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects / Q000627:therapeutic use; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects / Q000627:therapeutic use; D017135:Desogestrel / Q000009:adverse effects / Q000627:therapeutic use; D005165:Factor V / Q000235:genetics; D005260:Female; D006801:Humans; D008875:Middle Aged; D017354:Point Mutation; D011372:Progestins / Q000009:adverse effects / Q000627:therapeutic use; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D019851:Thrombophilia / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control
chemical_list: D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D011372:Progestins; C095381:factor V Leiden; D017135:Desogestrel; D005165:Factor V