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Risk of Venous Thrombosis With Use of Current Low-Dose Oral Contraceptives Is Not Explained by Diagnostic Suspicion and Referral Bias
Kitty W. M. Bloemenkamp, MD;
Frits R. Rosendaal, MD;
Harry R. Büller, MD;
Frans M. Helmerhorst, MD;
Louisa P. Colly, MD;
Jan P. Vandenbroucke, MD
Arch Intern Med. 1999;159:65-70.
Background The magnitude of the relative risk of venous thrombosis caused by low-dose oral contraceptive use is still debated because previous studies might have been affected by diagnostic suspicion and referral bias.
Methods We conducted a case-control study in which the effect of diagnostic suspicion and referral bias was excluded. The study was performed in 2 diagnostic centers to which patients with clinically suspected deep vein thrombosis of the leg were referred. History of oral contraceptive use was obtained before objective testing for thrombosis. Young females with an objective diagnosis of deep vein thrombosis were considered case patients, and those who were referred with the same clinical suspicion but who had no thrombosis served as control subjects. Participants were seen between September 1, 1982, and October 18, 1995: 185 consecutive patients and 591 controls aged 15 to 49 years with a first episode of venous thrombosis and without malignant neoplasms, pregnancy, or known inherited clotting defects.
Results The overall odds ratio for oral contraceptive use was 3.2 (95% confidence interval [CI], 2.3-4.5); after adjustment for age, family history of venous thrombosis, calendar time, and center, the odds ratio was 3.9 (95% CI, 2.6-5.7). In the idiopathic group (120 patients and 413 controls, excluding recent surgery, trauma, or immobilization), the odds ratio for oral contraceptive use was 3.8 (95% CI, 2.5-5.9); after adjustment, the odds ratio was 5.0 (95% CI, 3.1-8.2).
Conclusions In this study, in which patients and controls were subject to the same referral and diagnostic procedures, we found similar relative risk estimates for oral contraceptive use as in previous studies. We conclude that diagnostic suspicion and referral bias did not play an important role in previous studies and that the risk of venous thrombosis with use of current brands of oral contraceptives still exists.
From the Departments of Obstetrics, Gynecology, and Reproductive Medicine (Drs Bloemenkamp and Helmerhorst), and Clinical Epidemiology (Drs Rosendaal and Vandenbroucke), and the Thrombosis and Hemostasis Research Centre (Dr Rosendaal), University Hospital Leiden, Leiden; and the Centre for Hemostasis, Thrombosis, Atherosclerosis and Inflammation Research, Academic Medical Centre of the University of Amsterdam (Dr Büller), and the Amsterdam Thrombosis Service and Laboratory for General Practitioners (Dr Colly), Amsterdam, the Netherlands.
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