Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery

Austin V. Stone; Avinesh Agarwalla; Anirudh K. Gowd; Cale A. Jacobs; Jeffrey A. Macalena; Bryson P. Lesniak; Nikhil N. Verma; Anthony A. Romeo; Brian Forsythe

doi:10.1177/2325967118822970

Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery

Austin V. Stone, Avinesh Agarwalla, Anirudh K. Gowd, Cale A. Jacobs, Jeffrey A. Macalena, Bryson P. Lesniak, Nikhil N. Verma, Anthony A. Romeo, Brian Forsythe

Orthopaedic Surgery

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Background: Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis. Purpose: To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking OCPs. A matched group was subsequently created to evaluate the incidence of VTE in similar patients with and without OCP use. Results: A total of 57,727 patients underwent arthroscopic shoulder surgery from 2007 to 2016, and 26,365 patients (45.7%) were female. At the time of surgery, 924 female patients (3.5%) were taking OCPs. The incidence of vascular thrombosis was 0.57% (n = 328) after arthroscopic shoulder surgery, and there was no significant difference in the rate of vascular thrombosis in male or female patients (0.57% vs 0.57%, respectively; P >.99). The incidence of VTE in female patients taking and not taking OCPs was 0.22% and 0.57%, respectively (P =.2). In a matched-group analysis, no significant difference existed in VTE incidence between patients with versus without OCP use (0.22% vs 0.56%, respectively; P =.2). On multivariate analysis, hypertension (odds ratio [OR], 2.00; P <.001) and obesity (OR, 1.43; P =.002) were risk factors for VTE. Conclusion: OCP use at the time of arthroscopic shoulder surgery is not associated with an increased risk of VTE. Obesity and hypertension are associated with a greater risk for thrombolic events, although the risk remains very low. Our findings suggest that patients taking OCPs should be managed according to the surgeon’s standard prophylaxis protocol for arthroscopic shoulder surgery.

Original language	English (US)
Journal	Orthopaedic Journal of Sports Medicine
Volume	7
Issue number	1
DOIs	https://doi.org/10.1177/2325967118822970
State	Published - Jan 1 2019

Bibliographical note

Funding Information:
One or more of the authors has declared the following potential conflict of interest or source of funding: A.V.S. receives research support from Smith & Nephew. J.A.M. is a paid speaker/presenter for Vericel and the Musculoskeletal Transplant Foundation; has received educational support from Arthrex, Medwest Associates, and Smith & Nephew; has received a grant from Arthrex; has received hospitality payments from Arthrex and the Musculoskeletal Transplant Foundation; and has received compensation for expenses incurred during consultation from Arthrex and Smith & Nephew. B.P.L. receives royalties from Wolters Kluwer Health and has received educational support from Arthrex. N.N.V. is a paid consultant for Arthrex, Medacta, Minivasive, OrthoSpace, and Smith & Nephew; receives research support from Arthrex, Arthrosurface, DJ Orthopedics, Ossur, Athletico, ConMed Linvatec, Miomed, and Mitek; receives royalties from SLACK, Smith & Nephew, and Vindico Medical (Orthopedics Hyperguide); has stock/stock options in CyMedica, Mini-vasive, and Omeros; has received educational support from Medwest Associates; has received compensation for expenses incurred during consultation from Pacira Pharmaceuticals; and has received hospitality payments from Arthrex. A.A.R. receives research support from Major League Baseball, SLACK, and Arthrex; receives research support from Aesculap/B. Braun, Arthrex, Histogenics, Medipost, NuTech, OrthoSpace, Smith & Nephew, and Zimmer; receives royalties from Arthrex; is a consultant for Arthrex; is a paid speaker/presenter for Arthrex; and has received hospitality payments from Arthrex. B.F. receives royalties from Elsevier, receives research support from Arthrex and Stryker, has stock/stock options in Jace Medical, has received fellowship support from Smith & Nephew and Ossur, is a consultant for Stryker and Sonoma Orthopedics, has received educational support from Medwest Associates, is a paid speaker/presenter for Arthrosurface, and has received hospitality payments from Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval was not sought for the present study.

Publisher Copyright:
© The Author(s) 2019.

Keywords

complications
deep vein thrombosis
oral contraceptives
shoulder arthroscopic surgery

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@article{f58978835c1b4f00912fe8367a289ebe,

title = "Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery",

abstract = "Background: Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis. Purpose: To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking OCPs. A matched group was subsequently created to evaluate the incidence of VTE in similar patients with and without OCP use. Results: A total of 57,727 patients underwent arthroscopic shoulder surgery from 2007 to 2016, and 26,365 patients (45.7%) were female. At the time of surgery, 924 female patients (3.5%) were taking OCPs. The incidence of vascular thrombosis was 0.57% (n = 328) after arthroscopic shoulder surgery, and there was no significant difference in the rate of vascular thrombosis in male or female patients (0.57% vs 0.57%, respectively; P >.99). The incidence of VTE in female patients taking and not taking OCPs was 0.22% and 0.57%, respectively (P =.2). In a matched-group analysis, no significant difference existed in VTE incidence between patients with versus without OCP use (0.22% vs 0.56%, respectively; P =.2). On multivariate analysis, hypertension (odds ratio [OR], 2.00; P <.001) and obesity (OR, 1.43; P =.002) were risk factors for VTE. Conclusion: OCP use at the time of arthroscopic shoulder surgery is not associated with an increased risk of VTE. Obesity and hypertension are associated with a greater risk for thrombolic events, although the risk remains very low. Our findings suggest that patients taking OCPs should be managed according to the surgeon{\textquoteright}s standard prophylaxis protocol for arthroscopic shoulder surgery.",

keywords = "complications, deep vein thrombosis, oral contraceptives, shoulder arthroscopic surgery",

author = "Stone, {Austin V.} and Avinesh Agarwalla and Gowd, {Anirudh K.} and Jacobs, {Cale A.} and Macalena, {Jeffrey A.} and Lesniak, {Bryson P.} and Verma, {Nikhil N.} and Romeo, {Anthony A.} and Brian Forsythe",

note = "Funding Information: One or more of the authors has declared the following potential conflict of interest or source of funding: A.V.S. receives research support from Smith & Nephew. J.A.M. is a paid speaker/presenter for Vericel and the Musculoskeletal Transplant Foundation; has received educational support from Arthrex, Medwest Associates, and Smith & Nephew; has received a grant from Arthrex; has received hospitality payments from Arthrex and the Musculoskeletal Transplant Foundation; and has received compensation for expenses incurred during consultation from Arthrex and Smith & Nephew. B.P.L. receives royalties from Wolters Kluwer Health and has received educational support from Arthrex. N.N.V. is a paid consultant for Arthrex, Medacta, Minivasive, OrthoSpace, and Smith & Nephew; receives research support from Arthrex, Arthrosurface, DJ Orthopedics, Ossur, Athletico, ConMed Linvatec, Miomed, and Mitek; receives royalties from SLACK, Smith & Nephew, and Vindico Medical (Orthopedics Hyperguide); has stock/stock options in CyMedica, Mini-vasive, and Omeros; has received educational support from Medwest Associates; has received compensation for expenses incurred during consultation from Pacira Pharmaceuticals; and has received hospitality payments from Arthrex. A.A.R. receives research support from Major League Baseball, SLACK, and Arthrex; receives research support from Aesculap/B. Braun, Arthrex, Histogenics, Medipost, NuTech, OrthoSpace, Smith & Nephew, and Zimmer; receives royalties from Arthrex; is a consultant for Arthrex; is a paid speaker/presenter for Arthrex; and has received hospitality payments from Arthrex. B.F. receives royalties from Elsevier, receives research support from Arthrex and Stryker, has stock/stock options in Jace Medical, has received fellowship support from Smith & Nephew and Ossur, is a consultant for Stryker and Sonoma Orthopedics, has received educational support from Medwest Associates, is a paid speaker/presenter for Arthrosurface, and has received hospitality payments from Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval was not sought for the present study. Publisher Copyright: {\textcopyright} The Author(s) 2019.",

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doi = "10.1177/2325967118822970",

language = "English (US)",

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T1 - Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery

AU - Stone, Austin V.

AU - Agarwalla, Avinesh

AU - Gowd, Anirudh K.

AU - Jacobs, Cale A.

AU - Macalena, Jeffrey A.

AU - Lesniak, Bryson P.

AU - Verma, Nikhil N.

AU - Romeo, Anthony A.

AU - Forsythe, Brian

N1 - Funding Information: One or more of the authors has declared the following potential conflict of interest or source of funding: A.V.S. receives research support from Smith & Nephew. J.A.M. is a paid speaker/presenter for Vericel and the Musculoskeletal Transplant Foundation; has received educational support from Arthrex, Medwest Associates, and Smith & Nephew; has received a grant from Arthrex; has received hospitality payments from Arthrex and the Musculoskeletal Transplant Foundation; and has received compensation for expenses incurred during consultation from Arthrex and Smith & Nephew. B.P.L. receives royalties from Wolters Kluwer Health and has received educational support from Arthrex. N.N.V. is a paid consultant for Arthrex, Medacta, Minivasive, OrthoSpace, and Smith & Nephew; receives research support from Arthrex, Arthrosurface, DJ Orthopedics, Ossur, Athletico, ConMed Linvatec, Miomed, and Mitek; receives royalties from SLACK, Smith & Nephew, and Vindico Medical (Orthopedics Hyperguide); has stock/stock options in CyMedica, Mini-vasive, and Omeros; has received educational support from Medwest Associates; has received compensation for expenses incurred during consultation from Pacira Pharmaceuticals; and has received hospitality payments from Arthrex. A.A.R. receives research support from Major League Baseball, SLACK, and Arthrex; receives research support from Aesculap/B. Braun, Arthrex, Histogenics, Medipost, NuTech, OrthoSpace, Smith & Nephew, and Zimmer; receives royalties from Arthrex; is a consultant for Arthrex; is a paid speaker/presenter for Arthrex; and has received hospitality payments from Arthrex. B.F. receives royalties from Elsevier, receives research support from Arthrex and Stryker, has stock/stock options in Jace Medical, has received fellowship support from Smith & Nephew and Ossur, is a consultant for Stryker and Sonoma Orthopedics, has received educational support from Medwest Associates, is a paid speaker/presenter for Arthrosurface, and has received hospitality payments from Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval was not sought for the present study. Publisher Copyright: © The Author(s) 2019.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis. Purpose: To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking OCPs. A matched group was subsequently created to evaluate the incidence of VTE in similar patients with and without OCP use. Results: A total of 57,727 patients underwent arthroscopic shoulder surgery from 2007 to 2016, and 26,365 patients (45.7%) were female. At the time of surgery, 924 female patients (3.5%) were taking OCPs. The incidence of vascular thrombosis was 0.57% (n = 328) after arthroscopic shoulder surgery, and there was no significant difference in the rate of vascular thrombosis in male or female patients (0.57% vs 0.57%, respectively; P >.99). The incidence of VTE in female patients taking and not taking OCPs was 0.22% and 0.57%, respectively (P =.2). In a matched-group analysis, no significant difference existed in VTE incidence between patients with versus without OCP use (0.22% vs 0.56%, respectively; P =.2). On multivariate analysis, hypertension (odds ratio [OR], 2.00; P <.001) and obesity (OR, 1.43; P =.002) were risk factors for VTE. Conclusion: OCP use at the time of arthroscopic shoulder surgery is not associated with an increased risk of VTE. Obesity and hypertension are associated with a greater risk for thrombolic events, although the risk remains very low. Our findings suggest that patients taking OCPs should be managed according to the surgeon’s standard prophylaxis protocol for arthroscopic shoulder surgery.

AB - Background: Worldwide, more than 100 million women between the ages of 15 and 49 years take oral contraceptive pills (OCPs). OCP use increases the risk of venous thromboembolism (VTE) through its primary drug, ethinylestradiol, which slows liver metabolism, promotes tissue retention, and ultimately favors fibrinolysis inhibition and thrombosis. Purpose: To evaluate the effects of OCP use on VTE after arthroscopic shoulder surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A large national payer database (PearlDiver) was queried for patients undergoing arthroscopic shoulder surgery. The incidence of VTE was evaluated in female patients taking OCPs and those not taking OCPs. A matched group was subsequently created to evaluate the incidence of VTE in similar patients with and without OCP use. Results: A total of 57,727 patients underwent arthroscopic shoulder surgery from 2007 to 2016, and 26,365 patients (45.7%) were female. At the time of surgery, 924 female patients (3.5%) were taking OCPs. The incidence of vascular thrombosis was 0.57% (n = 328) after arthroscopic shoulder surgery, and there was no significant difference in the rate of vascular thrombosis in male or female patients (0.57% vs 0.57%, respectively; P >.99). The incidence of VTE in female patients taking and not taking OCPs was 0.22% and 0.57%, respectively (P =.2). In a matched-group analysis, no significant difference existed in VTE incidence between patients with versus without OCP use (0.22% vs 0.56%, respectively; P =.2). On multivariate analysis, hypertension (odds ratio [OR], 2.00; P <.001) and obesity (OR, 1.43; P =.002) were risk factors for VTE. Conclusion: OCP use at the time of arthroscopic shoulder surgery is not associated with an increased risk of VTE. Obesity and hypertension are associated with a greater risk for thrombolic events, although the risk remains very low. Our findings suggest that patients taking OCPs should be managed according to the surgeon’s standard prophylaxis protocol for arthroscopic shoulder surgery.

KW - complications

KW - deep vein thrombosis

KW - oral contraceptives

KW - shoulder arthroscopic surgery

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Oral Contraceptive Pills Are Not a Risk Factor for Deep Vein Thrombosis or Pulmonary Embolism After Arthroscopic Shoulder Surgery

Abstract

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UN SDGs

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