Use of common painkillers alongside hormonal contraception linked to heightened risk of blood clots

Ladies who use non-steroidal anti-inflammatory painkillers alongside hormonal contraception look like at a small elevated threat of blood clots often called venous thromboembolism (VTE), finds a big Danish research revealed by The BMJ at present.

The chance 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 threat of growing a critical blood clot is low, even in girls utilizing excessive threat hormonal contraception. However given the widespread use of each hormonal contraception and NSAIDs, they are saying girls must be suggested of this potential drug interplay accordingly.

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

To handle this, researchers used nationwide medical data 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 threat, based on their affiliation with VTE based mostly on earlier research.

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

A spread of probably influential components equivalent to age, schooling degree, being pregnant historical past, prior surgical procedure, hypertension and diabetes, had been additionally taken under consideration.

Within the research, NSAIDs had been utilized by 529,704 girls whereas utilizing hormonal contraception. Ibuprofen was probably the most continuously used NSAID (60%), adopted by diclofenac (20%) and naproxen (6%).

Over a median 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 additional venous thromboembolic occasions per week per 100,000 girls not utilizing hormonal contraception, 11 additional occasions in girls utilizing medium threat hormonal contraception, and 23 additional occasions in girls utilizing excessive threat hormonal contraception.

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

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

However, this was a big research based mostly on prime quality registry knowledge and the researchers had been in a position to regulate for a variety of probably influential components. What’s extra, the associations persevered after additional evaluation, suggesting that they’re strong.

As such, the researchers conclude, “Utilizing prime quality, linkable, nationwide registries, this nationwide research provides new data on the danger of a probably deadly occasion throughout concomitant use of two drug courses usually prescribed to in any other case wholesome girls.”

They add, “Ladies needing each hormonal contraception and common use of NSAIDs must be suggested accordingly.”

These knowledge increase essential considerations about utilizing NSAIDs, notably diclofenac, and excessive threat 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 options to NSAIDs for analgesia.

“If therapy with NSAIDs is required, brokers apart from diclofenac appear preferable, together with decrease threat hormonal contraceptives equivalent to progestin solely tablets, implants, or intrauterine units,” he concludes.