Assessment of the association between contraceptive use and thrombosis

Resumo

This study aimed to identify, synthesize, and critically evaluate scientific evidence on the association between the use of hormonal contraceptives and the occurrence of thrombosis, considering different formulations, routes of administration, and riskmodifying factors such as age, smoking, BMI, and thrombophilias. The review was conducted as a systematized narrative review, following PRISMA 2020 guidelines to ensure transparency and reproducibility. The research question was structured using the PICO/PECO framework, encompassing women of reproductive age exposed to combined or progestinonly contraceptives across various routes, compared with nonusers or users of alternative methods. Searches were performed in international and regional databases, complemented by grey literature and reference screening. Inclusion criteria covered observational studies, clinical trials, and systematic reviews that quantified thrombotic risk. Data extraction and quality assessment employed standardized tools, including NOS, ROBINSI, and AMSTAR 2. The synthesis revealed a consistent increase in venous thromboembolism risk among users of combined contraceptives, particularly those containing drospirenone and administered via nonoral routes. In contrast, progestinonly pills, implants, and levonorgestrelreleasing intrauterine systems demonstrated a more favorable safety profile, with no significant risk increase. Factors such as advanced age, smoking, high BMI, and thrombophilias amplified absolute risk, reinforcing the need for individualized assessment. The findings highlight the importance of risk stratification, shared decisionmaking, and public health policies that promote access to safer contraceptive methods. 

Keywords: Epidemiologia, Eventos adversos, Riscos cardiovasculares, Saúde reprodutiva.