POEMs

Third-Generation Oral Contraceptives Associated with Greater Risk of PE, Stroke, and MI

 


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Am Fam Physician. 2016 Oct 15;94(8):663.

Clinical Question

Which oral contraceptive combinations have the highest risk of cardiovascular effects?

Bottom Line

Although there is risk with any current oral contraceptive combination, those that contain lower doses of estrogen, and levonorgestrel instead of desogestrel or gestodene, are associated with the least risk of ischemic stroke, myocardial infarction (MI), or pulmonary embolism (PE). These safer products are older so are often less expensive. This is not the first study to show this difference, but its enrollment of 5 million women may make it the largest. (Level of Evidence = 2b)

Synopsis

This study, conducted in France, used the national health insurance database to identify all women who filled at least one

POEMs (patient-oriented evidence that matters) are provided by EssentialEvidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, please see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of POEMs published in AFP is available at http://www.aafp.org/afp/poems.



 

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