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

Girls who use non-steroidal anti-inflammatory painkillers alongside hormonal contraception seem like at a small elevated threat of blood clots generally known as venous thromboembolism (VTE), finds a big Danish research printed by The BMJ in the present day.

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 medication (NSAIDs) ibuprofen, diclofenac, and naproxen.

The researchers stress that absolutely the threat of growing a severe 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 needs to 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 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 residing 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, in response to their affiliation with VTE based mostly on earlier research.

Excessive threat hormonal contraception included mixed estrogen and progestin patches, vaginal rings, and capsules 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 variety of doubtless influential elements reminiscent of age, education level, being pregnant historical past, prior surgical procedure, high blood pressure and diabetes, had been additionally taken into consideration.

Within the research, NSAIDs had been utilized by 529,704 girls whereas utilizing hormonal contraception. Ibuprofen was probably the most ceaselessly 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 analysis.

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, reminiscent of lacking details about smoking and weight problems, which they are saying could have affected their outcomes.

However, this was a big research based mostly on top quality registry information and the researchers had been in a position to modify for a variety of doubtless influential elements. What’s extra, the associations persevered after additional evaluation, suggesting that they’re strong.

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

They add, “Girls needing each hormonal contraception and common use of NSAIDs needs to be suggested accordingly.”

These information elevate vital 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 accessible over-the-counter diclofenac, and girls utilizing hormonal contraception and their clinicians ought to think about alternate options to NSAIDs for analgesia.

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