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Clinical pharmacy and clinical trials (including case series)
Update on combined oral contraceptives: risk of venous thromboembolism. Drospirenone versus other progestins
  1. C. Martí Gil,
  2. A. Mulet Alberola,
  3. M. Mejía Recuero,
  4. D. Barreira Hernández,
  5. P. Llopis Salvia,
  6. D. Barreda Hernández
  1. 1Virgen de la Luz Hospital, Pharmacy Department, Cuenca, Spain

Abstract

Background The risk of venous thromboembolism (VTE) associated with combined oral contraceptives (COCs) is well known, but the relation with the progestin type is controversial.

Purpose To describe a suspected deep vein thrombosis (DVT) associated with drospirenone (DRSP)-containing COCs. Literature review about the VTE risk of versus DRSP and other progestins.

Materials and methods Medical record review. Search of PubMed (hormonal oral contraceptives, COCs, DRSP, combined DRSP and ethinyl oestradiol (EE), progestins, thromboembolism, VTE, drug toxicity.)

Results Woman, 36 years old, G4 A2 V2, dysmenorrhea, ovarian cysts and fibroadenoma, non-smoker, no allergies, user of NSAIDs and COCs (2007 – March 2010: 35 mcg EE/250 mcg norgestimate, March-November 2010: 20 mcg EE/75 mcg gestodene, November 2010-August 2011: 20 mcg EE/3 mg DRSP). On August 2011, was attended in an Internal Medicine Outpatient Consultation after a previous admission in which a radiological test ruled out DVT, although D-dimers (DDs)=1220 ng/mL. She was readmitted to hospital due to persistent induration and pain in right calf (DD= 571 ng/mL). DVT was suspected again and a Doppler ultrasound was confirmatory. Low molecular weight heparin was initiated, followed by acenocoumarol. She was discharged (medium compression stockings, acenocoumarol and analgesics). The COC was stopped and she was referred to the Gynaecology Outpatient Consultation. Suspected adverse drug reaction (ADR) was reported to the regional pharmacovigilance centre.

Conclusions Spontaneously reporting ADRs can improve the safety profile of drugs. Our case adds further information to the recently published epidemiological studies that suggest an increased risk of VTE associated with DRSP.

CPC096 table 1

Literature review

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