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• W2024534095 abstract "Authors' reply Sir—First, we must apologise for and correct several errors in our letter (see Department of Error, p 1478). Our study was limited to episodes of first, exclusive use of third or second generation oral contraceptives among new users. Therefore, we first converted all prescriptions of oral contraceptives into episodes of exclusive use, on the basis of the numbers prescribed and dispensed cycles. Most women had more than one episode of contraceptive use, either because they stopped taking oral contraceptives for a period of 1–2 years or they switched to other methods of contraception (<5%). To compare our data with those of others we need to extend our study to recurrent users. In the total population, including new and recurrent users, we saw 78 cases of DVT during 209 706 person-years use of second and third generation oral contraceptives. The overall incidence rate (new and recurrent users) was 3·7/10 000 person-years with 5·5/10 000 person-years (49/88 295) for users of third generation oral contraceptives and 2·4/10 000 person-years (29/121 411) for users of second generation oral contraceptives, giving a crude relative risk of 2·3 (95% CI 1·5–3·7). These rates and relative risk corroborate the initial findings cited by Vandenbroucke1Vandenbroucke JP Helmerhorst FM Bloemenkamp KWM Rosendaal FR Third generation oral contraceptive and deep venous thrombosis: from epidemiologic controversy to new insight in coagulation.Am J Obstet Gynecol. 1997; 177: 887-891Summary Full Text Full Text PDF PubMed Scopus (76) Google Scholar and Walker2Walker AM Newer oral contraceptives and the risk of venous thromboembolism.Contraception. 1998; 57: 169-181Summary Full Text Full Text PDF PubMed Scopus (83) Google Scholar and their colleagues. Our results are also in line with Farmer and colleagues'3Farmer RDT Lawrenson RA Thompson CR Kennedy JG Hambleton IR Population-based study of venous thromboembolism associated with various oral contraceptives.Lancet. 1997; 349: 83-88Summary Full Text Full Text PDF PubMed Scopus (348) Google Scholar findings with respect to the major potential confounding role of age and calendar year. By contrast, we limited the number of confounders by restricting the exposure in our main analysis to new, exclusive users of second or third generation oral contraceptives. We controlled for age differences and date of initiation of oral-contraceptive use by including age and year of onset of use as continuous variables in our Poisson regression models. Our findings clearly show that the risk difference between third and second generation oral contraceptives is strongest among new, healthy users of third generation oral contraceptives. Despite being able to follow up drug use for most women since their childhood to detect first use of oral contraceptives, we cannot entirely exclude past use of oral contraceptives. However, any undetected past use would lead us to underestimate the relative risk we report. Differences between new and recurrent use were only recorded for third generation contraceptive (9·0/10 000 vs 3·8/10 000 person-years, and 2·4/10 000 vs 2·4/10 000 person-years for third and second generation oral contraceptives). Furthermore, the risk differences between third and second generation contraceptives declined from an eightfold to a two-fold risk difference over time. Most thromboemboli were seen during the first year of use and virtually all thromboemboli occurred before the end of the second year of use. The risk in the first year of use was increased compared with long-term use for both second and third generation oral contraceptives. These data are in line with Kitty Bloemenkamp and colleagues' conclusions, although we have no data on genetic susceptibility. Further research is necessary to ascertain the mechanisms behind the small but seemingly definite differences in risk attributable to the second and third generation oral contraceptives. A noteworthy conclusion is that women who have used these contraceptives for more than 1 year without an episode of DVT have safely run the gauntlet of modestly raised risk. Venous thromboembolism and oral contraceptivesWe are pleased that 5 years after the first studies, R M C Herings and colleagues (July 10, p 127)1 have confirmed the difference in venous thromboembolism risk between second and third generation oral contraceptives. The difference in risk is highest among the youngest women who were exposed to sex steroids for the first time, as suggested in two of the original studies.2,3 Full-Text PDF Venous thromboembolism and oral contraceptivesR M C Herings and colleagues1 report a four-fold increased risk of thromboembolic disease among users of third-generation compared with second-generation combined oral contraceptives. This difference they report as highest among the youngest women who used oral contraceptives for the first time. We wonder whether the investigators or other readers can explain the very high rates of thromboembolic disease in all users of oral contraceptives in this study compared with results from previous studies. Full-Text PDF" @default.
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• W2024534095 title "Venous thromboembolism and oral contraceptives" @default.
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