This nationwide cohort study examined the risk of venous thromboembolism (VTE) associated with use of hormonal contraception and non-steroidal anti-inflammatory drugs (NSAIDs). The study included over 2 million Danish women aged 15-49 followed between 1996-2017. NSAID use was found to increase VTE risk, with the highest risk increase seen in women using high-risk hormonal contraception. NSAID use led to 4-23 additional VTE events per 100,000 women per year depending on contraceptive method used. The study concludes NSAID use poses a greater VTE risk when combined with hormonal contraception, particularly high-risk methods. Women using both should be informed of

1. Venous thromboembolism
with use of hormonal
contraception and non-
steroidal anti-inflammatory
drugs: nationwide cohort
study
Dr. Robert Ferris

2. The
Study

3. Methodology
 Nationwide cohort study
 All Danish women aged 15-49 between
1996 and 2017, with no hx. of:
◦ thrombotic events
◦ cancer
◦ thrombophilia
◦ hysterectomy, bilateral oophorectomy or
sterilisation
◦ infertility treatment
 N=2,029,065
 Outcome measure of first-time discharge
dx. of lower limb deep venous thrombosis
or PE

4. Methodology
 Hormonal contraceptive methods were stratified
into three VTE-risk categories, based on existing
literature
 High-risk:
◦ combined oestrogen + progestogen patch
◦ vaginal ring
◦ tablets containing 50 µg ethinyl oestradiol
◦ tablets containing desogestrel, gestodene or
drospirenone
◦ anti-androgen cyproterone
 Medium-risk:
◦ all other combined oral contraceptives
◦ medroxyprogesterone injection
 No/Low-risk:
◦ progestin-only tablets/implants
◦ hormonal IUDs

5. Results
 Approx. 2m women, 8,710 incidents of VTE
 NSAID use associated with VTE incidence
rate ratio of
◦ 7.2 in women not using hormonal contraception
◦ 4.5 in women using no/low-risk contraception
◦ 7.9 in women using medium-risk contraception
◦ 11.0 in women using high-risk contraception
 Extra VTE events per 100,000 in first 1/52
NSAID vs. no-NSAID tx.
◦ 4 in women not using hormonal contraception
◦ 3 in women using no/low-risk contraception
◦ 11 in women using medium-risk contraception
◦ 23 in women using high-risk contraception

6. Conclusion
 NSAID use was positively associated with the
development of venous thromboembolism in
women of reproductive age.
 The number of extra venous thromboembolic
events with NSAID use compared with non-
use was significantly larger with concomitant
use of high/medium risk hormonal
contraception compared with concomitant
use of low/no risk hormonal contraception.
 Women needing both hormonal contraception
and regular use of NSAIDs should be advised
accordingly.

7. References
 Meaidi, A. et al. (2023), ‘Venous
thromboembolism with use of hormonal
contraception and non-steroidal anti-
inflammatory drugs: nationwide cohort
study’, BMJ 2023 Sep 6;382:e074450.
doi: 10.1136/bmj-2022-074450, PMID:
37673431
 ‘Contraceptive’, accessed at
https://en.wikipedia.org/wiki/File:Pilule_
contraceptive.jpg on 01/10/2023