title: Drospirenone-containing combined oral contraceptives and the risk of arterial thrombosis: a population-based nested case-control study.
abstract: OBJECTIVE
  To compare the rate of arterial thromboembolism (ATE) of drospirenone-containing COCs to that of levonorgestrel-containing COCs.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  United Kingdom's Clinical Practice Research Datalink (CPRD), which contains clinical records for >11 million patients.
  
  
  METHODS
  Women aged 16-45 years prescribed a drospirenone- or levonorgestrel-containing COC between May 2002 and June 2012.
  
  
  METHODS
  We conducted nested case-control analyses using risk set sampling to randomly select up to 10 controls for each ATE case, matched on age, cohort entry year, CPRD registration year, COC user type (first-time ever, new, switcher, or prevalent users), duration of COC use, duration of progestin-only or implantable contraceptive use, pre-cohort entry duration of drospirenone and levonorgestrel use, and duration of follow up.
  
  
  METHODS
  We used conditional logistic regression to estimate hazard ratios and 95% confidence intervals (CIs), adjusted for high-dimensional propensity scores.
  
  
  RESULTS
  Our cohort included 339 743 women followed over a mean 4.4 years, during which 228 ATE cases occurred: 37 myocardial infarctions, 170 strokes, and 21 other ATEs; overall rate: 1.5 events per 10 000 person-years (PYs). After adjusting for potential confounders, the hazard ratio for ATE with current use of drospirenone-containing COCs versus current use of levonorgestrel-containing COCs was 0.89 (95% CI 0.35, 2.28), corresponding to a rate difference of -0.16 events per 10 000 PYs.
  
  
  CONCLUSIONS
  The overall rate of ATE in this population is low regardless of which COC was taken. We found little evidence of a difference in the rate of ATE with drospirenone- versus levonorgestrel-containing COCs.
  
  
  CONCLUSIONS
  Little evidence was found of a greater incidence of arterial thrombosis with drospirenone versus levonorgestrel contraceptives.
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Larivée
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.|Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Suissa
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Eberg
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.|Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Joseph
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.|Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: M J
authors.initials: MJ
authors.lastname: Eisenberg
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.|Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
authors.forename: H A
authors.initials: HA
authors.lastname: Abenhaim
authors.affiliation: Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.|Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
authors.forename: K B
authors.initials: KB
authors.lastname: Filion
mesh_terms: D000293:Adolescent; D000328:Adult; D000736:Androstenes / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000627:therapeutic use*; D008875:Middle Aged; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000139:chemically induced / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000736:Androstenes; D003277:Contraceptives, Oral, Combined; D016912:Levonorgestrel; C035144:drospirenone
keywords: Arterial thromboembolism; drospirenone; drug safety; oral contraceptives