The incidence and prognosis of thromboembolism associated with oral contraceptives: Age-dependent difference in Japanese population

The Effect of Wearing Elastic Compression Stockings on Leg Edema in Pregnant Women in Late Pregnancy as Determined by Measuring the Deep Venous Velocity and Flow

Background: The present study evaluated the objective effectiveness of wearing compression stockings during late pregnancy on leg edema by measuring changes in venous velocity and blood flow. Methods: Using Doppler ultrasonography, we calculated the popliteal venous velocity and blood flow and compared them in the following four groups: (1) 13 non-pregnant women (26 legs) without leg edema, (2) 23 pregnant women (46 legs) in late pregnancy without leg edema, (3) 22 pregnant women (44 legs) in late pregnancy with leg edema who were followed up without treatment, and (4) 21 pregnant women (42 legs) in late pregnancy with leg edema who wore elastic compression stockings for 1 week. Results: Both the average velocity and blood flow of the popliteal vein of pregnant women's legs in late pregnancy were significantly lower than those in non-pregnant women (6.32 ± 0.28 cm/s vs. 9.14 ± 0.37 cm/s; 118.48 ± 8.83 mL/min vs. 177.73 ± 11.74 mL/min, p < 0.0001, respectively). Furthermore, both the average venous velocity and blood flow in edematous legs in late pregnancy were significantly lower than those in non-edematous legs (5.32 ± 0.93 cm/s vs. 6.32 ± 0.28 cm/s; 82.68 ± 35.90 mL/min vs. 118.48 ± 8.83 mL/min, p < 0.0001, respectively). Finally, both the average venous velocity and blood flow were significantly higher in edematous legs in late pregnancy after wearing stockings than without treatment (7.69 ± 0.17 cm/s vs. 5.36 ± 0.17 cm/s; 143.22 ± 48.74 mL/min vs. 97.03 ± 40.07 mL/min, p < 0.0001, respectively). Conclusions: The wearing of elastic compression stockings by women with edematous legs in late pregnancy significantly increases the deep venous velocity and flow. Thus, it is possible to prevent deep vein thrombosis in this population.

Willingness to pay for short- and long-acting contraceptives among female adolescents and their parents in Brazil:a pilot study

Objective

To evaluate willingness to pay for short- and long-acting reversible contraceptive methods among female Brazilian adolescents and their parents, as well as their perspective on using such methods.

Methods

This is a cross-sectional study of female adolescents aged 13 to 19 years and their parents. We surveyed to estimate their willingness to pay for contraceptive methods. The values are expressed as mean±standard deviation in Brazilian reals (R$). Spearman correlation was employed for socioeconomic status of parents, age of adolescents and their standpoints. The methods types and adolescent and parent perspectives were analyzed by the test χ². To determine an agreement between pairs and their willingness to pay, we used the Bland-Altman plot.

Results

A total of 165 surveys were collected. Short-acting method was significantly more acceptable to pay than the long-action method, by both parents and their daughters. Parents and their daughters are willing to pay out-of-pocket R$ 52,25±22,48 and R$ 51,63±21,24 for short-acting reversible contraception method, and R$ 176,83±130,34 and R$ 174,83±143,64, for long-acting method, respectively. Bland-Altman analysis indicated an agreement on both perspectives and the price they are willing to pay for each contraceptive method.

Conclusion

Parents and adolescent daughters are more willing to pay for short-acting methods. We showed an agreement between the parent and the daughter for the values paid for each method.

The epidemiological characteristics of thromboembolism related to oral contraceptives in Japan: Results of a national survey

AIM

The aim of this study was to reveal the epidemiological characteristics of thromboembolism related to combined oral contraceptives (COCs) in Japan.

METHODS

A survey of confirmed thromboembolism patients among Japanese COC users was conducted at randomly selected hospitals from across Japan. The survey examined six types of venous thromboembolism (VTE) and arterial thromboembolism (ATE) in all COC users: pulmonary embolism, deep vein thrombosis, other venous thrombosis, cerebral infarction, myocardial infarction, and other arterial thrombosis. The survey covered 5 years from 2009 to 2013. This study was approved in an ethical review by Hamamatsu University School of Medicine.

RESULTS

Four hundred and twenty-five cases clearly related to COCs were analyzed. The annual estimated incidence rates per 10 000 person-years of VTE, ATE and all thromboembolisms in all COC users were 1.17, 0.33 and 1.50, respectively. The incidence of thromboembolism was 35.2% within 30 days from the start of COCs, 53.8% within 90 days, 66.9% within 180 days and 78.2% within 360 days regardless of progestin type. Age adjusted odds ratios in the obese and underweight groups were 2.33 and 0.98 for overall thromboembolism, 2.59 and 0.77 for VTE, and 1.11 and 1.28 for ATE compared with the standard group, respectively. Odds ratios for thromboembolism in non-O blood groups were 1.89 for overall thromboembolism, 2.16 for VTE, and 1.35 for ATE, when compared with the O blood group.

CONCLUSION

The epidemiological characteristics of COC-related thromboembolisms were revealed in this national survey covering the years from 2009 to 2013.