{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:24:20Z","timestamp":1792797860178,"version":"4.5.0"},"reference-count":43,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2017,5,5]],"date-time":"2017-05-05T00:00:00Z","timestamp":1493942400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Fonds de Recherche Qu\u00e9bec - Sant\u00e9 (Quebec Health Research Fund)"},{"name":"Canadian Institutes of Health Research (CIHR) New Investigator Award","id":[{"id":"https:\/\/ror.org\/01gavpb45","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2017,9]]},"abstract":"\n Background<\/jats:title>\n \n The effects of fourth\u2010generation drospirenone\u2010containing combined oral contraceptives (\n COC<\/jats:styled-content>\n s) on the risk of venous thromboembolism (\n VTE<\/jats:styled-content>\n ) are controversial.\n <\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n \n To assess the methodological strengths and limitations of the evidence on the\n VTE<\/jats:styled-content>\n risk of these\n COC<\/jats:styled-content>\n s.\n <\/jats:p>\n <\/jats:sec>\n \n Search strategy<\/jats:title>\n \n We searched\n CINAHL<\/jats:styled-content>\n , the Cochrane Library,\n EMBASE<\/jats:styled-content>\n , HealthStar, Medline, and the Science Citation Index.\n <\/jats:p>\n <\/jats:sec>\n \n Selection criteria<\/jats:title>\n Studies were included if they were cohort and case\u2013control studies, reported a venous thrombotic outcome, had a comparator group, reported an effect measure of the association of interest, and were published in English or French.<\/jats:p>\n <\/jats:sec>\n \n Data collection and analysis<\/jats:title>\n \n We assessed study quality using the\n ROBINS<\/jats:styled-content>\n \u2010I tool and assessed the presence of four common sources of bias: prevalent user bias, inappropriate choice of comparator,\n VTE<\/jats:styled-content>\n misclassification, and confounding.\n <\/jats:p>\n <\/jats:sec>\n \n Main results<\/jats:title>\n \n Our systematic review included 17 studies. The relative risks of\n VTE<\/jats:styled-content>\n associated with drospirenone\u2010 versus second\u2010generation levonorgestrel\u2010containing\n COC<\/jats:styled-content>\n s ranged from 1.0 to 3.3. Based on\n ROBINS<\/jats:styled-content>\n \u2010I, three studies had a moderate risk, ten had a serious risk, and four had a critical risk. Nine studies included prevalent users, four included inappropriate comparators, four had\n VTE<\/jats:styled-content>\n misclassification, and five did not account for two or more important confounding factors. The three highest quality studies had relative risks ranging from 1.0 to 1.57.\n <\/jats:p>\n <\/jats:sec>\n \n Author's conclusions<\/jats:title>\n \n As a result of the methodological limitations of the individual studies, the\n VTE<\/jats:styled-content>\n risk of drospirenone\u2010containing\n COC<\/jats:styled-content>\n s remains unknown. The highest quality studies suggest there are no or slightly increased harmful effects, but their confidence limits do not rule out an almost doubling of the risk.\n <\/jats:p>\n <\/jats:sec>\n \n Tweetable abstract<\/jats:title>\n \n Systematic review of drospirenone: best studies show no or slightly increased\n VTE<\/jats:styled-content>\n risk (versus levonorgestrel).\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/1471-0528.14623","type":"journal-article","created":{"date-parts":[[2017,3,9]],"date-time":"2017-03-09T03:19:56Z","timestamp":1489029596000},"page":"1490-1499","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Drospirenone\u2010containing oral contraceptive pills and the risk of venous thromboembolism: a systematic review of observational studies"],"prefix":"10.1111","volume":"124","author":[{"given":"N","family":"Lariv\u00e9e","sequence":"first","affiliation":[{"name":"Center for Clinical Epidemiology Lady Davis Institute Jewish General Hospital Montreal QC Canada"},{"name":"Department of Epidemiology, Biostatistics and Occupational Health McGill University Montreal QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Suissa","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology Lady Davis Institute Jewish General Hospital Montreal QC Canada"},{"name":"Department of Epidemiology, Biostatistics and Occupational Health McGill University Montreal QC Canada"},{"name":"Department of Medicine, McGill University McGill University Montreal QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F","family":"Khosrow\u2010Khavar","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology Lady Davis Institute Jewish General Hospital Montreal QC Canada"},{"name":"Department of Epidemiology, Biostatistics and Occupational Health McGill University Montreal QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V","family":"Tagalakis","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology Lady Davis Institute Jewish General Hospital Montreal QC Canada"},{"name":"Division of General Internal Medicine Jewish General Hospital Montreal QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KB","family":"Filion","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology Lady Davis Institute Jewish General Hospital Montreal QC Canada"},{"name":"Department of Epidemiology, Biostatistics and Occupational Health McGill University Montreal QC Canada"},{"name":"Department of Medicine, McGill University McGill University Montreal QC Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,5,5]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2012.11.002"},{"key":"e_1_2_6_3_1","unstructured":"Prevention CfDCa.Contraceptive Use 2010[www.cdc.gov\/nchs\/fastats\/contraceptive.htm]. 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