TY - JOUR
T1 - Risk of recurrence in women with venous thromboembolism related to estrogen-containing contraceptives
T2 - Systematic review and meta-analysis
AU - Wiegers, Hanke M. G.
AU - Knijp, Jannet
AU - van Es, Nick
AU - Coppens, Michiel
AU - Moll, Stephan
AU - Klok, Frederikus A.
AU - Middeldorp, Saskia
N1 - Funding Information: HW and JK have nothing to disclose. NvE reports advisory board fees from Bayer, Daiichi Sankyo, and LEO Pharma, which were transferred to his institution, all outside the submitted work. MC reports personal fees from Bayer, Boehringer Ingelheim, Bristol‐Myers Squib, CSL Behring, Daiichi Sankyo, Pfizer, Portola, and Sanquin Blood Supply, all outside the submitted work. STM reports consulting fees from Bristol‐Myers‐Squibb, outside the submitted work. FAK reports research grants from Bayer, Bristol‐Myers‐Squibb, Boehringer‐Ingelheim, Daiichi‐Sankyo, MSD and Actelion, the Dutch Heart foundation (2017T064) and the Dutch Thrombosis association, all outside the submitted work. SAM reports grants and personal fees from Bayer, BMS Pfizer, Boehringer Ingelheim, Daiichi Sankyo, Portola, all during the conduct of the study; personal fees form Abbvie, personal fees from Sanofi, all outside the submitted work. Publisher Copyright: © 2022 The Authors. Journal of Thrombosis and Haemostasis published by Wiley Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.
PY - 2022/5
Y1 - 2022/5
N2 - Background: The risk of recurrence after a venous thromboembolism (VTE) related to estrogen-containing contraceptives is a key driver to guide anticoagulant treatment decisions. Objective: To estimate the incidence rate of recurrent VTE after discontinuation of anticoagulant treatment in women with a first episode of VTE related to estrogen-containing contraceptives. Methods: Embase, MEDLINE, and the CENTRAL were searched from 1 January 2008 to 27 May 2021 for prospective and retrospective studies reporting on recurrence after a first VTE related to estrogen-containing contraceptives. Risk of bias was assessed using QUIPS tool. Recurrence rates per 100 patient-years were pooled using Knapp-Hartung random-effects meta-analysis. Incidence rates were reported separately based on study follow-up duration (≤1 year, 1–5 years, and >5 years) and for several subgroups. Results: A total of 4,120 studies were identified, of which 14 were included. The pooled recurrence rate was 1.57 (95%-CI: 1.10–2.23; I2 = 82%) per 100 patient-years. Recurrence rates per 100 patient-years were 2.73 (95%-CI: 0.00–3643; I2 = 80%) for studies with ≤1 year follow-up, 1.35 (95%-CI: 0.68–2.68; I2 = 44%) for studies with 1–5 years follow-up, and 1.42 (95%-CI: 0.84–2.42; I2 = 78%) for studies with >5 years follow-up. Conclusion: Among women with VTE associated with estrogen-containing contraceptives, the risk of recurrence after stopping anticoagulation is low, which favors short-term anticoagulation. Large prospective studies on VTE recurrence rates and risk factors after stopping short-term anticoagulants are needed.
AB - Background: The risk of recurrence after a venous thromboembolism (VTE) related to estrogen-containing contraceptives is a key driver to guide anticoagulant treatment decisions. Objective: To estimate the incidence rate of recurrent VTE after discontinuation of anticoagulant treatment in women with a first episode of VTE related to estrogen-containing contraceptives. Methods: Embase, MEDLINE, and the CENTRAL were searched from 1 January 2008 to 27 May 2021 for prospective and retrospective studies reporting on recurrence after a first VTE related to estrogen-containing contraceptives. Risk of bias was assessed using QUIPS tool. Recurrence rates per 100 patient-years were pooled using Knapp-Hartung random-effects meta-analysis. Incidence rates were reported separately based on study follow-up duration (≤1 year, 1–5 years, and >5 years) and for several subgroups. Results: A total of 4,120 studies were identified, of which 14 were included. The pooled recurrence rate was 1.57 (95%-CI: 1.10–2.23; I2 = 82%) per 100 patient-years. Recurrence rates per 100 patient-years were 2.73 (95%-CI: 0.00–3643; I2 = 80%) for studies with ≤1 year follow-up, 1.35 (95%-CI: 0.68–2.68; I2 = 44%) for studies with 1–5 years follow-up, and 1.42 (95%-CI: 0.84–2.42; I2 = 78%) for studies with >5 years follow-up. Conclusion: Among women with VTE associated with estrogen-containing contraceptives, the risk of recurrence after stopping anticoagulation is low, which favors short-term anticoagulation. Large prospective studies on VTE recurrence rates and risk factors after stopping short-term anticoagulants are needed.
KW - contraceptive agents
KW - estrogens
KW - systematic review
KW - thrombosis
KW - women
UR - http://www.scopus.com/inward/record.url?scp=85124569575&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/jth.15661
DO - https://doi.org/10.1111/jth.15661
M3 - Article
C2 - 35108438
SN - 1538-7933
VL - 20
SP - 1158
EP - 1165
JO - Journal of thrombosis and haemostasis
JF - Journal of thrombosis and haemostasis
IS - 5
ER -