There appears to be no significant difference in thromboembolism risk between new users of combined hormonal contraceptives (CHC) and progestin-only contraceptives (POC) among patients with sickle cell disease (SCD), according to a study published in Blood Advances.
Given the increased risk of morbidity and mortality associated with pregnancy in SCD, broad access to safe and effective family planning tools are needed, especially contraceptives. However, there is a paucity of data regarding the use and safety of contraceptives among females with SCD. This impairs patients’ ability to make informed decisions about their reproductive health.
The authors of the study sought to evaluate the risk of thromboembolism in the first year after initial contraceptive prescription. They chose to compare 2 commonly used contraceptive medications: CHC and POC. The research team accessed data from the Centers for Medicare and Medicaid Services Medicaid Analytic eXtract and Transformed Analytic Files data systems from 2006 to 2018. Both databases contain information from Medicaid enrollees across the United States.
The research team narrowed their inclusion criteria to females of a reproductive age between 12 and 44 years of age who have been diagnosed with SCD. In addition, they must be new users of contraceptives and have a washout period of 6 months or more prior to starting. Patients were followed up for 1 year after commencing contraception, with particular attention focused on thromboembolism events during the first 3 to 6 months, when it most commonly occurs.
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A total of 7173 patients were included in this study. Among them, 44.6% were prescribed CHC, while 55.4% were prescribed POC. One hundred twenty-six patients (1.8%) developed a thromboembolic event within the first year of contraceptive use; the most common type was pulmonary embolism (n=62; 49.2%), followed by deep vein thrombosis (n=51; 40.5%). There was no difference in the hazard ratio between users of CHC vs POC in terms of thromboembolic risk.
“These data empower patients with SCD to make the appropriate choices with evidence-based information and also provide data to physicians to help guide prescription practices,” the authors concluded.
Bala NS, Stanek JR, Vesely SK, et al. Comparison of thromboembolism outcomes in patients with sickle cell disease prescribed hormonal contraception. Blood Adv. Published online August 16, 2023. doi:10.1182/bloodadvances.2023010204