{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T19:45:40Z","timestamp":1791229540946,"version":"4.1.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","funder":[{"name":"Aase og Ejnar Danielsens Fond","award":["22-10-0078"],"award-info":[{"award-number":["22-10-0078"]}]},{"name":"Familien Hede Nielsens Fond","award":["2022-0226"],"award-info":[{"award-number":["2022-0226"]}]}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The commonly used combined hormonal contraceptives with progestins and ethinylestradiol are associated with an increased risk of ischemic stroke (IS). Progestin-only preparations, including levonorgestrel-releasing intrauterine devices (LG-IUDs), are not associated with an increased risk, and in smaller studies, the risk is even reduced. The risk of intracerebral hemorrhage (ICH) has never been investigated. We studied the risk of IS and ICH in women using LG-IUDs compared with women not using hormonal contraceptives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>In this Danish historical cohort study (2004\u20132021), we followed nonpregnant women (18\u201349 years) registering incident IS and ICH in relation to use of LG-IUDs\/nonuse of hormonal contraceptives utilizing Danish high-quality registries with nationwide coverage. Poisson regression models adjusting for age, ethnicity, education, calendar year, and medication use for risk factors were applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>A total of 1\u2005681\u2005611 nonpregnant women contributed 11\u2005971\u2005745 person-years (py) of observation. Mean age at inclusion was 30.0 years; mean length of follow-up was 7.1 years; 2916 women (24.4 per 100\u2005000 py) had IS; 367 (3.1 per 100\u2005000 py) had ICH. Of these, 364\u2005784 were users of LG-IUD contributing 1\u2005720\u2005311 py to the investigation; mean age at start of usage was 34.6 years. Nonusers of hormonal contraceptives contributed 10\u2005251\u2005434 py; mean age at inclusion was 30.0 years. The incidence rate of IS\/ICH among LG-IUD users was 19.2\/3.0 and among nonusers, it was 25.2\/3.1 per 100\u2005000 py. After adjustment, incidence rate ratio for IS was 0.78 (CI, 0.70\u20130.88), and for ICH it was 0.94 (CI, 0.69\u20131.28).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>The use of LG-IUD was associated with a 22% lower incidence rate of IS without raising the incidence rate of ICH. The finding raises the question of whether levonorgestrel, in addition to its contraceptive properties, could have the potential to prevent IS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.124.047438","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T14:22:35Z","timestamp":1715869355000},"page":"1830-1837","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Risk of Stroke in Women Using Levonorgestrel-Releasing Intrauterine Device for Contraception"],"prefix":"10.1161","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3817-5430","authenticated-orcid":true,"given":"Gasper","family":"Letnar","sequence":"first","affiliation":[{"name":"Omicron ApS, Copenhagen, Denmark (G.L., K.K.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3573-092X","authenticated-orcid":true,"given":"Klaus Kaae","family":"Andersen","sequence":"additional","affiliation":[{"name":"Omicron ApS, Copenhagen, Denmark (G.L., K.K.A.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7462-4789","authenticated-orcid":true,"given":"Tom Skyh\u00f8j","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark (T.S.O.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2015.04.021"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487318774847"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1111840"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e2990"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S103662"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/1403494811399956"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1177\/1403494810394717"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.str.20.10.1407"},{"key":"e_1_3_3_10_2","doi-asserted-by":"crossref","first-page":"e1711","DOI":"10.1212\/WNL.0000000000011636","article-title":"Nationwide trends in incidence and mortality of stroke among younger and older adults in Denmark.","volume":"96","author":"Skajaa N","year":"2021","unstructured":"Skajaa, N, Adelborg, K, Horvath-Puho, E, Rothman, KJ, Henderson, VW, Thygesen, LC, S\u00f8rensen, HT. Nationwide trends in incidence and mortality of stroke among younger and older adults in Denmark. Neurology. 2021;96:e1711\u2013e1723.","journal-title":"Neurology"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1159\/000102143"},{"key":"e_1_3_3_12_2","unstructured":"Dansk Stroke Register. National \u00e5rsrapport 2022. Accessed February 22 2024. https:\/\/www.sundhed.dk\/content\/cms\/69\/4669_danstroke_aarsrapport-2022_offentlig-version_201130.pdf"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S50449"},{"key":"e_1_3_3_14_2","first-page":"291","article-title":"Initiating hormonal contraception.","volume":"103","author":"Lesnewski R","year":"2021","unstructured":"Lesnewski, R. Initiating hormonal contraception. 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