Use of frequent painkillers alongside hormonal contraception linked to heightened danger of blood clots

Girls who use non-steroidal anti-inflammatory painkillers alongside hormonal contraception look like at a small elevated danger of blood clots referred to as venous thromboembolism (VTE), finds a big Danish examine revealed by The BMJ in the present day.

The danger was larger in girls utilizing mixed oral contraceptives containing third or fourth technology progestins, however smaller in girls utilizing progestin-only tablets, implants and coils, alongside the non-steroidal anti-inflammatory medicine (NSAIDs) ibuprofen, diclofenac, and naproxen.

The researchers stress that absolutely the danger of creating a critical blood clot is low, even in girls utilizing excessive danger hormonal contraception. However given the widespread use of each hormonal contraception and NSAIDs, they are saying girls ought to be suggested of this potential drug interplay accordingly.

NSAIDs have beforehand been linked to blood clots, however little is thought about whether or not utilizing NSAIDs influences the chance of venous thromboembolism in in any other case wholesome girls utilizing hormonal contraception.

To deal with this, researchers used nationwide medical information to trace first time diagnoses of venous thromboembolism amongst 2 million girls aged 15 to 49 years dwelling in Denmark between 1996 and 2017 with no historical past of blood clots, most cancers, hysterectomy or fertility therapy.

Hormonal contraception was divided into excessive, medium and low danger, based on their affiliation with VTE primarily based on earlier research.

Excessive danger hormonal contraception included mixed estrogen and progestin patches, vaginal rings, and capsules containing both 50 mcg estrogen or third or fourth technology progestins. Medium danger contraception included all different mixed oral contraceptives and the medroxyprogesterone injection, whereas progestin-only tablets, implants, and hormone intrauterine units (coils) have been classed as low or no danger.

A spread of doubtless influential components corresponding to age, schooling stage, being pregnant historical past, prior surgical procedure, hypertension and diabetes, have been additionally taken into consideration.

Within the examine, NSAIDs have been utilized by 529,704 girls whereas utilizing hormonal contraception. Ibuprofen was essentially the most steadily used NSAID (60%), adopted by diclofenac (20%) and naproxen (6%).

Over a mean 10-year monitoring interval, 8,710 venous thromboembolic occasions occurred (2,715 pulmonary embolisms and 5,995 deep venous thromboses), and 228 (2.6%) girls died inside 30 days of their prognosis.

In absolute phrases, NSAID use was related to 4 further venous thromboembolic occasions per week per 100,000 girls not utilizing hormonal contraception, 11 further occasions in girls utilizing medium danger hormonal contraception, and 23 further occasions in girls utilizing excessive danger hormonal contraception.

Amongst particular person NSAIDs, the affiliation was strongest for diclofenac in contrast with ibuprofen and naproxen.

That is an observational examine, so cannot set up trigger, and the researchers spotlight a number of limitations, corresponding to lacking details about smoking and weight problems, which they are saying could have affected their outcomes.

However, this was a big examine primarily based on prime quality registry knowledge and the researchers have been in a position to alter for a variety of doubtless influential components. What’s extra, the associations endured after additional evaluation, suggesting that they’re strong.

As such, the researchers conclude, «Utilizing prime quality, linkable, nationwide registries, this nationwide examine provides new information on the chance of a probably deadly occasion throughout concomitant use of two drug lessons usually prescribed to in any other case wholesome girls.»

They add, «Girls needing each hormonal contraception and common use of NSAIDs ought to be suggested accordingly.»

These knowledge elevate vital considerations about utilizing NSAIDs, notably diclofenac, and excessive danger hormonal contraception concomitantly, writes Morten Schmidt at Aarhus College Hospital, in a linked editorial.

He means that well being care authorities and regulators ought to embrace these findings of their security evaluation of obtainable over-the-counter diclofenac, and ladies utilizing hormonal contraception and their clinicians ought to contemplate alternate options to NSAIDs for analgesia.

«If therapy with NSAIDs is required, brokers aside from diclofenac appear preferable, together with decrease danger hormonal contraceptives corresponding to progestin solely tablets, implants, or intrauterine units,» he concludes.