丹麦哥本哈根大学Amani Meaidi团队研究了静脉血栓栓塞与同时使用激素避孕与非甾体抗炎药的相关性。这一研究成果于2023年9月6日发表在《英国医学杂志》上。

该研究旨在探讨同时使用激素避孕和非甾体抗炎药（NSAIDs）对静脉血栓栓塞风险的影响，研究组在丹麦通过国家登记处进行了一项全国性队列研究。招募1996至2017年间居住在丹麦的所有15-49岁女性，无任何静脉或动脉血栓形成事件、癌症、血栓形成倾向、子宫切除术、双侧卵巢切除术、绝育或不孕治疗病史（n=2029065）。主要结局为首次出院诊断为下肢深静脉血栓形成或肺栓塞。

在对200万名女性进行了2100万人年的随访中，共发生了8710例静脉血栓栓塞事件。在不使用激素避孕的女性中，与不使用非甾体抗炎药相比，使用非甾体抗炎药与静脉血栓栓塞症的校正发病率比率为7.2，在使用高危激素避孕的女性中为11.0，在采用中危激素避孕的女性中为7.9，低风险/无风险激素避孕的女性中为4.5。

在非甾体类抗炎药治疗的第一周，与不使用非甾体抗炎药相比，每100000名女性中相应的静脉外血栓栓塞事件数在未使用激素避孕的女性中为4，在使用高风险激素避孕的女性中为23，在低风险/无风险激素避孕的女性中为3。

研究结果表明，非甾体抗炎药的使用与育龄妇女静脉血栓栓塞的发生呈正相关。与不使用非甾体抗炎药相比，同时使用高/中风险激素避孕与同时使用低/无风险激素避孕的静脉外血栓栓塞事件数量显著增加。同时需要激素避孕和定期使用非甾体抗炎药的妇女应得到相应的建议。

附：英文原文

Title: Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study

Author: Amani Meaidi, Annamaria Mascolo, Maurizio Sessa, Anne Pernille Toft-Petersen, Regitze Skals, Thomas Alexander Gerds, Charlotte Wessel Skovlund, Lina Steinrud Morch, Francesco Rossi, Annalisa Capuano, Oejvind Lidegaard, Christian Torp-Pedersen

Issue&Volume: 2023/09/06

Abstract:

Objective To study the influence of concomitant use of hormonal contraception and non-steroidal anti-inflammatory drugs (NSAIDs) on the risk of venous thromboembolism.

Design Nationwide cohort study.

Setting Denmark through national registries.

Participants All 15-49 year old women living in Denmark between 1996 and 2017 with no medical history of any venous or arterial thrombotic event, cancer, thrombophilia, hysterectomy, bilateral oophorectomy, sterilisation, or infertility treatment (n=2029065).

Main outcome measure A first time discharge diagnosis of lower limb deep venous thrombosis or pulmonary embolism.

Results Among 2.0 million women followed for 21.0 million person years, 8710 venous thromboembolic events occurred. Compared with non-use of NSAIDs, use of NSAIDs was associated with an adjusted incidence rate ratio of venous thromboembolism of 7.2 (95% confidence interval 6.0 to 8.5) in women not using hormonal contraception, 11.0 (9.6 to 12.6) in women using high risk hormonal contraception, 7.9 (5.9 to 10.6) in those using medium risk hormonal contraception, and 4.5 (2.6 to 8.1) in users of low/no risk hormonal contraception. The corresponding numbers of extra venous thromboembolic events per 100000 women over the first week of NSAID treatment compared with non-use of NSAIDs were 4 (3 to 5) in women not using hormonal contraception, 23 (19 to 27) in women using high risk hormonal contraception, 11 (7 to 15) in those using medium risk hormonal contraception, and 3 (0 to 5) in users of low/no risk hormonal contraception.

Conclusions 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.

DOI: 10.1136/bmj-2022-074450

Source: https://www.bmj.com/content/382/bmj-2022-074450