Venous thrombosis in users of non

AbstractObjective To assess the risk of venous thrombosis in current users of non oral hormonal contraception.Main outcome measures Incidence rate of venous thrombosis in users of transdermal, vaginal, intrauterine, or subcutaneous hormonal contraception, relative risk of venous thrombosis compared with non users, and rate ratios of venous thrombosis in current users of non oral products compared with the standard reference oral contraceptive with levonorgestrel and 30 40 g oestrogen. Diagnoses were confirmed by at least four weeks of anticoagulation therapy after the diagnosis.Results Within 9429128 woman years of observation, 5287 first ever venous thrombosis events were recorded, of which 3434 were confirmed. In non users of hormonal contraception the incidence rate of confirmed events was 2.1 per 10000 woman years. Compared with non users of hormonal contraception, and after adjustment for age, calendar year, and education, the relative risk of confirmed venous thrombosis in users of transdermal combined contraceptive patches was 7.9 (95% confidence interval 3.5 to 17.7) and of the vaginal ring was 6.5 (4.7 to 8.9). The corresponding incidences per 10000 exposure years were 9.7 and 7.8 events. The relative risk was increased in women who used subcutaneous implants (1.4, 0.6 to 3.4) but not in those who used the levonorgestrel intrauterine system (0.6, 0.4 to 0.8). Compared with users of combined oral contraceptives containing levonorgestrel, the adjusted relative risk of venous thrombosis in users of transdermal patches was 2.3 (1.0 to 5.2) and of the vaginal ring was 1.9 (1.3 to 2.7).Conclusion Women who use transdermal patches or vaginal rings for contraception have a 7.9 and 6.5 times increased risk of confirmed venous thrombosis compared with non users fashion cheap hermes handbags of hormonal contraception of the same age, corresponding to 9.7 and 7.8 events per 10000 exposure years. The risk was slightly increased in women using subcutaneous implants but not in those using the levonorgestrel intrauterine system.IntroductionSeveral studies have assessed the risk of venous thrombosis in women using oral contraceptives.1 2 3 4 5 6 7 8 9 10 However, none has assessed the risk in women using subcutaneous hormonal implants. A recent study reported a 48% higher risk of venous thrombosis in women using a vaginal ring compared with those using combined oral contraceptives containing levonorgestrel,11 and a few studies have reported the risk in women using a transdermal combined contraceptive patch, although the results were conflicting.12 13 14 15 16Using a historical national registry based cohort study design, we assessed the absolute and relative risk of venous thrombosis in Danish women using non oral hormonal contraception.MethodsInformation on the four national data sources that provided information for the study is provided in detail elsewhere.10 Briefly, from Statistics Denmark we obtained data on length of schooling, ongoing or finished education, vital status, and emigration of all Danish women aged 15 49 from 1 January 2001 to 31 December 2010. We censored women in cases of death or emigration.Since 1977 the national registry of patients has collected discharge diagnoses from all public and private hospitals in Denmark (see appendix for a list of the relevant diagnoses and codes used in this study). To include only first ever events, we excluded women with any type of venous or arterial thrombotic event before the study period (1977 2000), those with cancer, those who had undergone bilateral oophorectomy or hysterectomy, and those who had been sterilised. From study follow up we censored a woman's risk time during pregnancy, calculated from conception to three months after delivery, and women with a coagulation disorder from the first time such a diagnosis was recorded (appendix). The registry records only women admitted alive to hospital. Lethal events from venous thrombosis were captured in the national cause of death registry.A diagnosis of venous thrombosis was confirmed through prescribed anticoagulation therapy recorded in the national registry of medicinal products for at least four weeks after the diagnosis. Since 1 January 1994, and validated from 1995, information on filled prescriptions, including hormonal contraception, collected by the national registry of medicinal products has been complete. From this database we obtained information that had been updated daily on redeemed prescriptions of hormonal contraception from 1995 to 2010. We categorised the products in use according to progestogen type, oestrogen dose, and route of being administered. Duration of use was estimated from the prescribed defined daily doses from the date of prescription until the end date of defined daily doses of the last redeemed prescription or date of a study event. When hormonal contraception was switched without pause, we calculated duration as the sum of use before switch and current use of the new preparation. If a pause lasted for more than four weeks, we reset the length of use. To account for use before study start (left censoring bias), we allocated continuous users of hormonal contraception to replica birkin handbags the relevant duration of use category on 1 January 2001 by assessing use before the study period back to 1995.Women who used the levonorgestrel intrauterine system were censored after three years and included again when a new prescription of a hormonal contraceptive product was recorded. This was done owing to missing information on removal of these devices.Length of schooling and level of education were used as proxies for social class. Four strata were applied: elementary school education only, ongoing or completed high school education, high school and ongoing or ended middle length education, and high school and ongoing or ended long education. A fifth category included women without information on education, typically the youngest women.We controlled for calendar year to deal with potential secular confounding of increasing adiposity by time.Data on smoking were not available. Smoking is a weak risk factor for venous thrombosis in young women. However, we have no reason to believe in preferential prescribing of specific types of hormonal contraception among smokers. In Denmark the correlation between smoking and Hermes birkin bags fake length of education is strong. Thus, controlling for years of schooling and length of education may have captured most confounding (if any) influenced by smoking. Absolute as well as relative risk estimates were calculated. The reference group for the relative risk estimates was non users of all types of hormonal contraception (never users+former users). We calculated rate ratios for the different product types, with users of oral contraceptives containing 30 40 g oestrogen and levonorgestrel as reference. Tests for interaction with age and year were carried out.Relative risk estimates were adjusted for age, calendar year, length of schooling and education, and eventually for length of contraceptive use. For all relative risk estimates and replica hermes handbags outlet incidence rate ratios we calculated 95% confidence limits. We set the level of significance at PResultsAfter exclusions and censoring, 1626158 non pregnant women free of previous thrombotic diseases or cancer contributed 9429128 woman years of observation. During this time 5287 diagnoses of first ever venous thrombosis events were recorded, corresponding to 8.1 per 10000 woman years. Current users of hormonal contraception contributed 3536946 woman years and of these, 325849 concerned non oral products. Non users of hormonal contraception contributed 5892182 woman years, with an overall incidence of confirmed venous thrombosis of 2.1 per 10000 woman years. The incidence of venous thrombosis increased by 42.9% during the 10 year study period, or by 4.3% per year (table 1). After adjustment for calendar year and use of hormonal contraception, the incidence increased by 6.3 fold with increasing age and decreased by 51.2% with increasing length of education.Table 1 Crude incidence rate and adjusted relative risk of confirmed venous thrombosis according to age, calendar year, and length of educationView this table:View popupView inlineHormonal contraception and venous thrombosisCurrent use of combined oral contraceptives with 30 40 g oestrogen and levonorgestrel increased the risk of confirmed venous thrombosis by 3.2 (2.7 to 3.8), corresponding to an incidence of 6.2 events per 10000 exposure years (table 2).Table 2 Crude incidence rate and adjusted relative risk of venous thrombosis in current users of non oral hormonal contraception and combined oral contraceptives (COC) with non users as referenceView this table:View popupView inlineDuring 6178 woman years, six confirmed events of venous thrombosis were observed in association with transdermal combined contraceptive patches, corresponding to an incidence of 9.7 per 10000 exposure years. Compared with non users of hormonal contraception, the adjusted relative risk was 7.9 (3.5 to 17.7) and compared with users of oral contraceptives containing levonorgestrel the rate ratio was 2.5 (1.1 to 5.6, tables 2 and 3). After adjustment for length of use, the rate ratio was reduced to 2.3 (1.0 to 5.2). When compared with oral contraceptives containing the corresponding progestogen (norgestimate), the adjusted rate ratio was 2.2 (1.0 to 5.0).Table 3 Rate ratio estimates of venous thrombosis between users of different types of non oral hormonal contraception and users of combined oral contraceptives (COC) with levonorgestrel and 30 40 g oestrogen (reference group)

• sister must first choice Hermes orange preferential bag full
• young girls no doubt Preferred Hermes wine red imitation handbag distribute temperament
• daughter should The preferred Hermes blue imitation Birkin handbag full of charm
• women ought to first choice Hermes light blue knockoff male belt Issued charm
• sister ought to Select Hermes black replica men belt full of