Non-steroidal anti-inflammatory drugs and venous thromboembolism in women

• Published in: Pharmacoepidemiology and drug safety 2013-06, Vol.22 (6), p.658-666
• Main Authors: Bergendal, Annica, Adami, Johanna, Bahmanyar, Shahram, Hedenmalm, Karin, Lärfars, Gerd, Persson, Ingemar, Sundström, Anders, Kieler, Helle
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Biological and medical sciences; Blood and lymphatic vessels; Body Mass Index; Cardiology. Vascular system; Case-Control Studies; case-control study; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Drug toxicity and drugs side effects treatment; Embolisms; epidemiology; Farmakologi och toxikologi; Female; Humans; Incidence; Kardiologi; Klinisk medicin; Logistic Models; Medical sciences; Medicin och hälsovetenskap; Medicinska och farmaceutiska grundvetenskaper; Middle Aged; non-steroidal anti-inflammatory drugs; Nonsteroidal anti-inflammatory drugs; pharmacoepidemiology; Pharmacology; Pharmacology. Drug treatments; Polymorphism, Single Nucleotide; Registries; Risk factors; Sweden; Toxicity: cardiovascular system; venous thromboembolism; Venous Thromboembolism - chemically induced; Venous Thromboembolism - epidemiology; Venous Thromboembolism - genetics; women; Womens health; Young Adult
• ISSN: 1053-8569; 1099-1557; 1099-1557
• DOI: 10.1002/pds.3436

ABSTRACT Background Non‐steroidal anti‐inflammatory drugs (NSAIDs) might increase the risk of venous thromboembolism (VTE), and risks might differ by type of NSAID. Compared with men, women have a higher incidence of VTE at younger age, and they more often use NSAIDs. Objectives To assess risks of VTE in young and middle‐aged women in association with use of NSAIDs. Patients/Methods In a nationwide case–control study (Thrombo Embolism Hormone Study) performed in Sweden 2003–2009, we included as cases 1433 women, 18 to 64 years of age with a first time VTE. Controls were 1402 randomly selected women, frequency matched by age. Information was obtained by telephone interviews and DNA analyses of blood samples. We calculated adjusted odds ratios (ORs) with 95% confidence intervals (CIs) adjusting for degree of immobilization, chronic disease, smoking, body mass index, use of hormonal contraception, hormone therapy or other NSAIDs. Results Use of NSAIDs was not associated with increased risks of VTE (OR = 0.98, 95% CI 0.80–1.19). The OR was 0.88 for propionic acid derivatives (95% CI 0.72–1.10), 1.18 for acetic acid derivatives (95% CI 0.82–1.70) and 1.76 for coxibs (95% CI 0.73–4.27). For users of acetic acid derivatives and coxibs, the ORs increased by cumulative dose. Carriership of the prothrombin gene mutation or factor V Leiden had only minor effects on the results. Conclusions We found no increased risks of VTE in association with use of NSAIDs. Users of high cumulative doses of acetic acid derivatives and coxibs had the highest risks, suggesting a relationship with cyclooxygenase selectivity and dose. Copyright © 2013 John Wiley & Sons, Ltd.