Blood clot risk linked to taking common painkillers alongside certain hormonal birth control

Young woman pouring small white pills from a bottle onto her hand as she sits on her living room floor — In response to the examine, ladies who used sure “excessive threat” contraceptives, resembling estrogen-and-progestin patches or vaginal rings, alongside NSAIDs had been on the best threat of creating blood clots. (Picture credit score: Shutterstock)

Ladies who use some kinds of hormonal contraception and customary painkillers known as nonsteroidal anti-inflammatory medicine (NSAIDs) on the identical time might have a barely elevated threat of creating blood clots, new analysis suggests.

In an observational examine of two million ladies in Denmark revealed Wednesday (Sept. 6) within the journal The BMJ, researchers discovered that those that used NSAIDs similtaneously hormonal contraception had an elevated threat of creating blood clots of their veins, a doubtlessly disabling or lethal situation often called venous thromboembolism (VTE). NSAIDs embody medicine like ibuprofen, naproxen and diclofenac.

The examine authors emphasised that, even amongst ladies utilizing the highest-risk contraception possibility studied, absolutely the threat of VTE they noticed was nonetheless comparatively low — round 0.02% of girls within the highest-risk class. Nonetheless, they are saying the findings may assist inform well being care suppliers who’re advising sufferers on which medicine could also be best suited for them.

“Contemplating the tens of millions of girls uncovered to those drug lessons, it’s after all of curiosity, in a public well being matter, to cut back the chance of thrombosis [blood clots] in concomitant customers of those two drug lessons,” Dr. Amani Meaidi, lead creator of the examine and a postdoctoral researcher on the College of Copenhagen, informed Reside Science in an electronic mail.

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In previous research, hormonal contraceptives and NSAIDs have individually been linked to an elevated threat of creating VTE. Nonetheless, there was little analysis into whether or not utilizing each on the identical time may exacerbate this threat.

Within the new examine, researchers appeared on the medical data of 15- to 49-year-old ladies dwelling in Denmark between 1996 and 2017 who had by no means had a blood clot, most cancers, infertility remedy or surgical procedure to have their uterus eliminated. They tracked individuals’s prescriptions for hormonal contraception and NSAIDs utilizing Denmark’s Nationwide Registry of Medicinal Product Statistics. In all, greater than 529,000 ladies used hormonal contraception and NSAIDs on the identical time, with the most typical NSAIDs being ibuprofen, diclofenac and naproxen.

The workforce categorized various kinds of hormonal contraception into threat ranges primarily based on earlier research that investigated the chance of blood clots in individuals who took them. “Excessive-risk” contraceptives included mixed estrogen and progestin patches, vaginal rings, and capsules containing 50 micrograms of estrogen. Mixed oral contraceptives and medroxyprogesterone injections (Depo-Provera) had been deemed “medium threat,” and progestin-only tablets (typically known as “minipills”), implants and hormonal IUDs had been thought-about “low” or “no threat.”

They discovered that utilizing NSAIDs alone was linked to a barely elevated threat of blood clots, and that the chance was considerably amplified when a medium-to high-risk hormonal contraceptive was added.

The mixed threat is increased in ladies who additionally used high-risk contraception than in those that used medium- or low-risk varieties. For ladies who did not use hormonal contraception, for each 100,000 who used an NSAID for per week, the workforce estimated that an additional 4 would develop a blood clot than in the event that they did not use NSAIDs. This quantity stays about the identical for ladies utilizing NSAIDs with low-risk contraceptives, however it jumps to 11 for these utilizing medium-risk choices and to 23 for ladies on high-risk contraceptives.

“This doubtlessly suggests a synergistic drug interplay between these two drug lessons,” Meaidi stated. Nonetheless, within the paper, her and her co-authors observe that “additional analysis is warranted to find out the potential existence and mechanism of such drug interplay.”

The examine authors did spotlight a number of limitations of the analysis. As an example, they’re lacking info on smoking and weight problems charges amongst these studied, which can have affected the findings. Nor did they think about race or ethnicity, which may affect somebody’s threat of creating blood clots.

Additionally, as a result of this was an observational examine, it doesn’t present that both drug class, alone or mixed, immediately causes blood clots.

Dr. Andrew Kaunitz, a professor of obstetrics and gynecology on the College of Florida who was not concerned within the analysis, additionally stated it was attainable that a difficulty known as protopathic bias might clarify the findings. This time period describes when a drug is prescribed to deal with the preliminary signs of a illness that hasn’t but been recognized.

“Use of NSAIDs by reproductive age ladies may mirror early (not but recognized) situations, resembling lupus or rheumatoid arthritis, situations which themselves are related to an elevated threat of clot,” Kaunitz informed Reside Science in an electronic mail.

When contemplating the chance of blood clots tied to hormonal contraception, Kaunitz stated it is vital to maintain that threat in context. “You will need to remember that the situation which contraception prevents, notably being pregnant, is related to a a lot increased threat of blood clot than any contraceptive,” he stated.

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