Document Type
Article
Publication Date
2-7-2025
Abstract
Background: To date, research has identified positive associations between combined oral contraceptives (COCs) and adverse vascular events, however, evidence regarding the possible association with cervical artery dissection (CeAD) remains limited. We tested the hypothesis of a positive association between COCs and CeAD within one year following COC initiation compared to matched controls initiating intrauterine devices (IUDs), as measured by risk ratio (RR). Methods: We queried de-identified United States health records data (TriNetX, Inc.) from 2014 to 2024 for females aged 15–50 years without previous cerebrovascular disease or CeAD, creating mutually exclusive cohorts initiating either COCs or IUDs. We used propensity matching to control for variables associated with CeAD. Our primary outcome included the RR for CeAD within one year follow-up. We secondarily explored cumulative CeAD incidence and RR of stroke, also examining outcomes for females with ≥2 COC prescriptions (COC2). Results: After matching there were 214,020 patients per cohort (mean age 31 years). The incidence and risk of CeAD was greater among those prescribed COCs compared to matched controls with IUDs [95 % CI] (COCs: 0.016 %, IUDs: 0.008 %; RR 1.94 [1.10,3.43]; P = 0.0195). A similar association was observed for stroke (COCs: 0.106 %, IUDs: 0.057 %; RR = 1.86 [1.49,2.32]; P < 0.0001). The secondary COC2 analysis revealed similar findings. Conclusions: The present findings suggest that females prescribed COCs have an increased risk of CeAD and stroke compared to matched controls using IUDs. These observations should be viewed as preliminary, require corroboration by other studies, and in isolation do not replace the broader clinical and shared decision-making regarding contraceptive use.
Keywords
cardiovascular diseases, cerebrovascular disorders, contraceptive agents, contraceptive devices, ethinyl estradiol, progestin
Language
English
Publication Title
Thrombosis Research
Grant
UM1TR004528
Rights
© 2025 The Authors. This is an Open Access work distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Recommended Citation
Trager, Robert J. and Haering, Catherine P., "Association Between Combined Oral Contraceptive Prescription and Cervical Artery Dissection: A Retrospective Cohort Study" (2025). Faculty Scholarship. 1248.
https://commons.case.edu/facultyworks/1248
Manuscript Version
Final Publisher Version