CMAJ：PCOS患者服用口服避孕药静脉血栓栓塞风险增加2倍

发表于CMAJ（加拿大医学协会期刊）上的一项研究表明，服用复合口服避孕药的多囊卵巢综合症（PCOS）女性患者，与采用相同避孕方式的未患病女性相比，静脉血栓栓塞（venous thromboembolism）风险增加2倍。

PCOS影响着6~10%的育龄女性，是这一年龄组中最常见的内分泌疾病。PCOS患者中高血压、糖尿病、肥胖症及其他疾病风险，是未患PCOS女性的2倍。患者通常服用口服避孕药来调节月经周期，帮助治疗疾病相关的痤疮及毛发过度生长。然而，复方口服避孕药已知与增加的心血管事件风险相关。

来自美国及加拿大的研究人员，对美国87012例18~46岁的女性进行了调查，其中一半为PCOS患者，另一半为对照，来研究服用口服避孕药的PCOS患者，其静脉血栓栓塞风险是否会增加。研究中排除了既往心脏病、癌症、血液凝块病史的女性。

研究发现，与对照组相比，服用口服避孕药的PCOS患者，静脉血栓栓塞风险增加了2倍。在将PCOS疾病及治疗纳入PCOS定以后，研究人员也发现了一个类似的风险增加。与服用避孕药的对照组相比，不服用口服避孕药的PCOS患者静脉血栓栓塞风险增加1.5倍。

作者得出结论称，医生在开处方时，应考虑PCOS女性避孕治疗时增加的静脉血栓栓塞风险。

编译自：Risk of Blood Clots Two-Fold for Women With Polycystic Ovary Syndrome Taking Combined Oral Contraceptives, Study Finds

doi:10.1503/cmaj.120677
PMC:
PMID:

Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis.

Steven T. Bird, Abraham G. Hartzema, et al

Background: There is an increased risk of venous thromboembolism among women taking oral contraceptives. However, whether there is an additional risk among women with polycystic ovary syndrome (PCOS) is unknown. Methods: We developed a population-based cohort from the IMS LifeLink Health Plan Claims Database, which includes managed care organizations in the United States. Women aged 18–46 years taking combined oral contraceptives and who had a claim for PCOS (n = 43 506) were matched, based on a propensity score, to control women (n = 43 506) taking oral contraceptives. Venous thromboembolism was defined using administrative coding and use of anticoagulation. We used Cox proportional hazards models to assess the relative risk (RR) of venous thromboembolism among users of combined oral contraceptives with and without PCOS. Results: The incidence of venous thromboembolism among women with PCOS was 23.7/10 000 person-years, while that for matched controls was 10.9/10 000 person-years. Women with PCOS taking combined oral contraceptives had an RR for venous thromboembolism of 2.14 (95% confidence interval [CI] 1.41–3.24) compared with other contraceptive users. The incidence of venous thromboembolism was 6.3/10 000 person-years among women with PCOS not taking oral contraceptives; the incidence was 4.1/10 000 personyears among matched controls. The RR of venous thromboembolism among women with PCOS not taking oral contraceptives was 1.55 (95% CI 1.10–2.19). Interpretation: We found a 2-fold increased risk of venous thromboembolism among women with PCOS who were taking combined oral contraceptives and a 1.5-fold increased risk among women with PCOS not taking oral contraceptives. Physicians should consider the increased risk of venous thromboembolism when prescribing contraceptive therapy to women with PCOS.

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