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  • Title: [Oral contraceptives and cerebral thromboembolism. A Danish case-control study].
    Author: Lidegaard O.
    Journal: Ugeskr Laeger; 1993 Nov 01; 155(44):3538-45. PubMed ID: 8236574.
    Abstract:
    A retrospective case control study was carried out in order to assess the risk of developing cerebral thromboembolism by use of low dose oral contraceptives (OC). The subjects were all the 794 women in Denmark aged 15-44 who had suffered a cerebral thromboembolic attack (CTA) during the period 1985-1989, and an age-matched randomly selected control population of 1588 women. CTA included occlusion of precerebral arteria (ICD 432), cerebral thrombosis (ICD 433), cerebral embolism (ICD 434), transitory cerebral ischaemia (TCI; ICD 435) and the unspecified group apoplexia cerebri (ICD 436). Of 692/1584 case/control questionnaires sent out, 590/1396 (85.1/88.1%) were returned. Among the cases, 15 refused to participate, 69 had a revised or unreliable diagnosis, 40 had previously had thromboembolic disease, 13 were pregnant, and 152 had a disease predisposing them for CTA, leaving 323 without known predisposition, of whom 320 reported use/non-use of OC. Among 1396 controls, eight either refused to participate, were mentally retarded or resident in foreign countries; 18 returned an uncompleted questionnaire, 17 had previously had thromboembolic disease, 31 were pregnant, and 130 had a disease predisposing them to CTA. Thus, 1198 non-predisposed controls were provided, among whom 1197 reported use/non-use of OC. Among 320 cases, 116 (36.3%) were OC users at the time of the CTA, vs. 191 users (16.0%) among 1197 controls, corresponding to a crude odds ratio (OR) of 3.00.(ABSTRACT TRUNCATED AT 250 WORDS) A retrospective case control study was carried out in order to assess the risk of developing cerebral thromboembolism with the use of low-dose oral contraceptives (OC). The subjects were all the 794 women in Denmark aged 15-44 who had suffered a cerebral thromboembolic attack (CTA) during the period of January 1, 1985 and December 31, 1989, and an age-matched randomly selected control population of 1588 women. CTA included occlusion of precerebral arteria, cerebral thrombosis, cerebral embolism, transitory cerebral ischaemia, and the unspecified group apoplexia cerebri. 590 of 692 cases (85.1%) and 1396 of 1584 controls were provided, among whom 1197 reported use/non-use of OC. Among 320 cases, 116 (36.3%) were OC users at the time of the CTA vs. 191 users (16.0%) among 1197 controls, corresponding to a crude odds ratio (OR) of 3.00. After multivariate analysis including confounder control for age, smoking habits, years of schooling and the trend in use of different types of OC during the period 1985-1990, OC use with 50 mcg estrogen implied an OR for CTA of 2.9 (1.6-5.4), 30-40 mcg estrogen OC an OR of 1.8 (1.1-2.9), and pure progestogen minipills an OR of 0.9 (0.4-2.4), which was not significantly different from the risk of never users. The OR did not change significantly with duration of OC use or with increasing age. 63.6% of cases smoked compared to 48.8% of controls. After correction for age, OC use and the duration of education, smoking suggested an OR for CTA of 1.5-1.6 (1.1-2.4) (p 0.001). A 50% increased risk of developing CTA among cigarette smokers (after appropriate confounder control) was independent of OC status and age. Low-dose OC use suggests an increased risk of developing CTA. Combination or sequential OCs with 30-40 mcg estrogen represent a one-third reduced risk compared to preparations with 50 mcg estrogen. Minipills containing pure progestogen do not pose an increased risk of CTA.
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