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Relative risk compared with absolute risk for venous thromboembolism by characteristic

Relative risk compared with absolute risk for venous thromboembolism by characteristic
Variable Relative risk compared with nonpregnant women without the risk factor Absolute risk
Nonpregnant, not taking hormones 1.0 VTE: 1 to 5/10,000 woman-years[1]
Pregnancy 4.29 (95% CI 3.49-5.22; p<0.001) compared with nonpregnant women[2]

VTE: 5 to 20/10,000 woman-years[1]

PE: 1/10,000 woman-years
Postpartum 4.29 (95% CI 3.49-5.22; p<0.001) compared with nonpregnant women[2]

VTE: 40 to 65/10,000 woman-years[1]

PE: 16 per 10,000 woman-years
Progestin type* RR of VTE:[3,4]
  • First-generation versus non-use (norethindrone COC) users: 3.2 (95% CI 2.0-5.1)
  • Second-generation versus non-use (levonorgestrel COC) users: 2.8 (95% CI 2.0-4.1)
  • Third-generation versus non-use (desogestrel COC) users: 3.8 (95% CI 2.7-5.4)
  • Second-generation versus first-generation: 0.9 (95% CI 0.6-1.4)
  • Third-generation versus first- generation: 1.2 (95% CI 0.8-1.9)
  • Third-generation versus second-generation: 1.3 (95% CI 1.0-1.8)
  
Estrogen dose 20 mcg ethinyl estradiol with levonorgestrel versus non-use: 2.2 (95% CI 1.3-3.6)  
30 mcg ethinyl estradiol with levonorgestrel versus 20 mcg ethinyl estradiol with levonorgestrel: 1.1 (95% CI 0.7-1.7)  
50 mcg ethinyl estradiol with levonorgestrel versus 20 mcg ethinyl estradiol with levonorgestrel: 2.3 (95% CI 1.3-4.2)[3,4]  
Thrombophilias Factor V Leiden: 2.6 no OC, 5.73 (5.31-6.17)¶[5]  
Other heritable thrombophilia: Prothrombin mutation carriers 5.23 (4.67-5.87)¶[5]  
Although drospirenone is not listed, limited data suggest combined oral contraceptive pills containing drospirenone may be associated with a higher relative risk of VTE compared with second-generation (rate ratio 1.65, 95% CI 1.02-2.65) and third-generation (rate ratio 1.43, 95% CI 1.15-1.78) combined oral contraceptive pills.[6]

CI: confidence interval; COC: combined oral contraceptives; OC: oral contraceptives; PE: pulmonary embolism; RR: relative risk; VTE: venous thromboembolism.

* Progestin type used in combination with estrogen; formulation and dose not specified.

¶ Combined hetero- and homozygous patients, multiple OC types.

References:
  1. Committee on Gynecologic Practice. ACOG Committee Opinion Number 540: Risk of venous thromboembolism among users of drospirenone containing oral contraceptive pills. Obstet Gynecol 2012; 120:1239.
  2. Heit JA, Kobbervig CE, James AH, et al. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143:697.
  3. Stegeman BH, de Bastos M, Rosendaal FR, et al. Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network metaanalysis. BMJ 2013; 347:f5298.
  4. de Bastos M, Stegeman BH, Rosendaal FR, et al. Combined oral contraceptives: venous thrombosis. Cochrane Database Syst Rev 2014; :CD010813.
  5. Faro VL, Johansson T, Johansson A. The risk of venous thromboembolism in oral contraceptive users: the role of genetic factors-a prospective cohort study of 240,000 women in the UK Biobank. Am J Obstet Gynecol 2024; 230:360.e1.
  6. Gronich N, Lavi I, Rennert G. Higher risk of venous thrombosis associated with drospirenone-containing oral contraceptives: a population-based cohort study. CMAJ 2011; 183:E1319.

Original table modified for this publication. Practice Committee of the American Society for Reproductive Medicine. Combined hormonal contraception and the risk of venous thromboembolism: a guideline. Fertil Steril 2017; 107:43. Table used with the permission of Elsevier Inc.

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