Close
Enter your
text here

Weighing the Risk of Blood Clots With Reward of Less Pain

Weighing the Risk of Blood Clots With Reward of Less Pain 1024 683 Pam Georgiana

For people with sickle cell disease who menstruate, hormonal contraception can be effective against SCD-related pain, but it also raises the risk of thrombosis.

 

As people with sickle cell disease (SCD) transition into their reproductive years, health care providers are increasingly focused on optimizing their overall health, including the safe management of contraception.

For patients who menstruate, hormonal birth control is a contraceptive tool that offers both risks and benefits. Patients with SCD already have an increased risk of thromboembolism (TE), or blood clots. This risk complicates the use of hormonal contraception, which is known to increase the likelihood of TE. However, hormonal contraception is also an effective tool for managing SCD-related pain, particularly because menstruation is often a trigger for painful episodes.

Sarah H. O’Brien, MD, pediatric hematologist and principal investigator in the Center for Health Equity and Outcomes Research at the Abigail Wexner Research Institute at Nationwide Children’s Hospital, and a professor of pediatrics at The Ohio State University College of Medicine, is concerned about this dichotomy of risk versus reward.

“My team and I wanted to know how often doctors and SCD patients were choosing hormonal contraceptives and if those patients were experiencing blood clots at higher rates,” Dr. O’Brien says.

 

Investigating Hormonal Contraception in SCD Patients

Dr. O’Brien’s team reviewed Medicaid claims data from 2006-2018 for patients aged 12 to 44 years, who had received at least three diagnoses of SCD, had no recent history of blood clots, and were newly prescribed hormonal contraception. The patients were followed for one year after the initial prescription to assess TE risk.

“We used these parameters in an attempt to exclude patients who had sickle cell trait rather than true sickle cell disease or who had blood clots before taking contraceptives,” Dr. O’Brien explains. “That way, we can be reasonably sure of any correlations we find.”

The study, published in Blood Advances, examined the correlation between TE and different types of hormonal contraceptives, including combined hormonal contraceptives (CHCs) containing both estrogen and progestin and progestin-only contraceptives (POCs).

 

Study Findings

Of the 7,173 identified patients, 44.6% started taking CHCs, and 55.4% started POCs. A total of 1.8% of the patients had a new diagnosis of TE within 1 year of their first prescription. There were no significant differences in blood clot occurrences between CHC and POC users. Each group experienced a similar risk pattern. However, patients who were prescribed a transdermal patch instead of oral CH experienced a 2.4 times increased risk of TE.

“While we didn’t see a significant correlation between hormonal contraceptives and blood clots, limitations in the retrospective data we collected lead us to believe more study is needed to confirm a result,” Dr. O’Brien explains. “For example, it was to ascertain the duration of use of oral contraceptives. We could not be sure if patients were still taking an oral contraceptive when they had a blood clot.”

 

Implications for Clinical Practice

Given the complexity of managing SCD and the potential risks of hormonal contraception, the study’s findings emphasize the need for cautious decision-making.

“Our conclusion is that we cannot yet say which  hormonal contraception is safest for SCD patients,” Dr. O’Brien says. “More research is needed to draw definitive conclusions.”

The team is committed to further understanding this issue and is planning a follow-up retrospective study examining patient data from private insurance claims.

 

Updated Guidelines

In the meantime, new guidelines for prescribing contraception from the Centers for Disease Control and Prevention (CDC) offer clarity. The previous guidelines were published in 2016 and did not include specific recommendations for SCD. The new version does not endorse prescribing estrogen to women with SCD, calling it an “unacceptable health risk.”

“What we did learn from this study is that because so many doctors are prescribing estrogen-based contraceptives to patients with SCD, there may be an education gap on the associated risks,” Dr. O’Brien says.

Dr. O’Brien stresses that all doctors must understand and carefully consider the underlying TE risk factors for patients with SCD before prescribing hormonal contraception.

 

References:

  1. Bala NS, Stanek JR, Vesely SK, et al. Comparison of thromboembolism outcomes in patients with sickle cell disease prescribed hormonal contraception. Blood Advances. 2023;7(20):6140-6150. doi:10.1182/bloodadvances.2023010204
  2. Nguyen AT, Curtis KM, Tepper NK, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep 2024;73(No. RR-4):1–126. DOI: http://dx.doi.org/10.15585/mmwr.rr7304a1

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

You might also like