Risk of venous thromboembolism in women taking the combined oral contraceptive: a systematic review and meta-analysis

Background: Much scientific, media and patient interest surrounds the risk of venous thromboembolism (VTE) in women taking combined oral contraceptives (COCs). Objectives: We conducted a systematic review and meta-analysis to assess VTE risk in women taking COCs, focusing on drospirenone. Methods: Literature searches of clinical studies on COCs in which VTE was reported were undertaken in May 2015. No overall estimate of VTE risk between drospirenone-containing COCs and other COCs was produced because of heterogeneity of the study designs. Results: The final review and meta-analysis included 15 studies. No increased risk of VTE with drospirenone was seen in prospective or case control studies, but the risk of VTE was increased in retrospective cohort and nested case control studies. Discussion: The difference in risk of VTE based on the choice of progestin in COCs is, at worst, very small in absolute terms and should not be the sole factor considered when choosing the 'right' COC for each woman.Deborah Bateson, Belinda E Butcher, Catherine Donovan, Louise Farrell, Gab Kovacs, Tonia Mezzini, Camille Raynes-Greenow, Gino Pecoraro, Christine Read, Rod Babe