The risk of venous thromboembolism in women with superficial venous thrombosis who use combined hormonal contraceptives: a systematic review and meta-analysis

ABSTRACT

Objective. The use of combined hormonal contraceptives (CHCs) has been linked to an elevated risk of thrombosis. Understanding the relationship between CHC use with the incidence of venous thromboembolism (VTE) in women with superficial venous thrombosis (SVT) becomes imperative to ensure patient safety. Limited evidence prompted this study to assess the associated risk.

Methods. Three databases (Cochrane Library, Scopus, PubMed) have been systematically searched for identifying relevant studies. A meta-analysis was conducted to assess the impact of CHCs on VTE incidence with women with SVT, employing a random-effects model with pooled ORs calculated using the Mantel-Haenszel method. Publication bias was evaluated through funnel plots.

Results. A total of 3984 cases from five countries have been identified from nine studies (1 cross-sectional, 1 RCT, 7 longitudinal studies). The pooled OR was 0.85 (CI [0.58, 1.23] P = 0.38, I² = 0%), indicating no significant difference in the odds of VTE incidence between CHC users and controls. Subgroup analysis of RCT and longitudinal studies and leave-one-out sensitivity present no alteration in heterogeneity and significance. When adjusted for confounders (history of immobilization, cancer, and history of VTE), CHC use in SVT patients showed a non-significant increase in VTE odds (OR 1.43, CI [0.43, 4.68] P = 0.56, I² = 0%). No evidence of publication bias was observed.

Conclusions. This meta-analysis found no statistically significant link between CHCs use and the risk of developing VTE in women with SVT. Further research is recommended to clarify the risk.