Using Common Painkillers Alongside Birth Control Pills Increases Your Risk of Blood Clots
New analysis finds an elevated danger of blood clots in women utilizing NSAIDs with hormonal contraception, notably high-risk varieties and diclofenac. The analysis requires larger consciousness and cautious consideration of safer ache aid and contraceptive choices.
Researchers advise that whereas absolutely the danger stays low, women ought to be knowledgeable accordingly.
People utilizing non-steroidal anti-inflammatory painkillers together with hormonal contraceptives could face a barely greater danger of venous thromboembolism (VTE), based on a complete Danish examine not too long ago printed in The BMJ.
The danger was larger in women utilizing mixed oral contraceptives containing third or fourth-generation progestins, however smaller in women utilizing progestin-only tablets, implants, and coils, alongside the non-steroidal anti-inflammatory medication (NSAIDs) ibuprofen, diclofenac, and naproxen.
The researchers stress that absolutely the danger of growing a critical blood clot is low, even in women utilizing high-risk hormonal contraception. But given the widespread use of each hormonal contraception and NSAIDs, they are saying women ought to be suggested of this potential drug interplay accordingly.
Classification of Hormonal Contraception and NSAID Use
NSAIDs have beforehand been linked to blood clots, however little is understood about whether or not utilizing NSAIDs influences the danger of venous thromboembolism in in any other case healthy women utilizing hormonal contraception.
To handle this, researchers used nationwide medical information to trace first-time diagnoses of venous thromboembolism amongst 2 million women aged 15 to 49 years residing in Denmark between 1996 and 2017 with no historical past of blood clots, most cancers, hysterectomy, or fertility remedy.
Hormonal contraception was divided into high, medium, and low danger, based on their affiliation with VTE based mostly on earlier research.
High-risk hormonal contraception included mixed estrogen and progestin patches, vaginal rings, and drugs containing both 50 mcg estrogen or third or fourth-generation progestins. Medium-risk contraception included all different mixed oral contraceptives and the medroxyprogesterone injection, whereas progestin-only tablets, implants, and hormone intrauterine units (coils) had been classed as low or no danger.
A variety of doubtlessly influential components similar to age, training degree, pregnancy historical past, prior surgical procedure, high blood pressure, and diabetes, had been additionally taken under consideration.
In the examine, NSAIDs had been utilized by 529,704 women whereas utilizing hormonal contraception. Ibuprofen was essentially the most frequently used NSAID (60%), adopted by diclofenac (20%) and naproxen (6%).
Over a mean 10-year monitoring interval, 8,710 venous thromboembolic occasions occurred (2,715 pulmonary embolisms and 5,995 deep venous thromboses), and 228 (2.6%) women died inside 30 days of their analysis.
Implications and Recommendations
In absolute phrases, NSAID use was related to 4 additional venous thromboembolic occasions per week per 100,000 women not utilizing hormonal contraception, 11 additional occasions in women utilizing medium-risk hormonal contraception, and 23 additional occasions in women utilizing high-risk hormonal contraception.
Among particular person NSAIDs, the affiliation was strongest for diclofenac in contrast with ibuprofen and naproxen.
This is an observational examine, so can’t set up trigger, and the researchers spotlight a number of limitations, similar to lacking details about smoking and weight problems, which they are saying could have affected their outcomes.
Nevertheless, this was a big examine based mostly on high-quality registry information and the researchers had been capable of regulate for a variety of doubtlessly influential components. What’s extra, the associations persevered after additional evaluation, suggesting that they’re sturdy.
As such, the researchers conclude: “Using high quality, linkable, national registries, this nationwide study adds new knowledge on the risk of a potentially fatal event during concomitant use of two drug classes often prescribed to otherwise healthy women.”
They add: “Women needing both hormonal contraception and regular use of NSAIDs should be advised accordingly.”
These information increase necessary issues about utilizing NSAIDs, notably diclofenac, and high-risk hormonal contraception concomitantly, writes Morten Schmidt at Aarhus University Hospital, in a linked editorial.
He means that healthcare authorities and regulators ought to embrace these findings of their security evaluation of obtainable over-the-counter diclofenac, and women utilizing hormonal contraception and their clinicians ought to contemplate alternate options to NSAIDs for analgesia.
“If treatment with NSAIDs is needed, agents other than diclofenac seem preferable, along with lower-risk hormonal contraceptives such as progestin-only tablets, implants, or intrauterine devices,” he concludes.
The examine was funded by the Danish Heart Foundation.
