What are the risks and management strategies for venous thromboembolism (VTE) in women over 35 who use oral contraceptive pills (OCP) and vape?

From the Guidelines

Women over 35 who use oral contraceptive pills (OCP) and vape are at a significantly increased risk of venous thromboembolism (VTE), and management strategies should prioritize minimizing this risk through alternative contraception methods and vaping cessation. The risk of VTE is already increased in women taking OCP, with a threefold increase in the risk of deep vein thrombosis (DVT) 1. This risk may be further increased in the presence of other factors such as smoking, which is also an independent risk factor for pulmonary embolism, as shown in the Nurses’ study 1. Although vaping is not explicitly mentioned in the provided evidence, its effects on endothelial damage, inflammation, and hypercoagulability are likely to be similar to those of smoking, thereby potentially further elevating VTE risk. Key considerations for managing VTE risk in these women include:

• Switching to alternative contraception methods such as progestin-only pills, intrauterine devices, or barrier methods to reduce the risk associated with estrogen-containing OCPs.
• If OCPs must be continued, selecting formulations with lower estrogen doses and second-generation progestins can help mitigate the risk.
• Vaping cessation is crucial, with potential aids including nicotine replacement therapy, varenicline, or bupropion.
• Regular monitoring for VTE symptoms and preventive measures during high-risk periods, such as long flights, are also essential. Given the potential for increased risk, a comprehensive approach addressing both modifiable risk factors and maintaining effective contraception is necessary to minimize the risk of VTE in women over 35 who use OCP and vape.

From the FDA Drug Label

The risk of thromboembolic disease associated with oral contraceptives is not related to length of use and disappears after pill use is stopped (2) Several epidemiologic studies indicate that third generation oral contraceptives, including those containing desogestrel, are associated with a higher risk of venous thromboembolism than certain second generation oral contraceptives (102 to 104) In general, these studies indicate an approximate two-fold increased risk, which corresponds to an additional 1 to 2 cases of venous thromboembolism per 10,000 women-years of use.

The FDA drug label does not directly address the risk of VTE in women over 35 who use OCP and vape. However, it does mention that smoking, which may be similar to vaping in terms of cardiovascular risk, increases the risk of thromboembolic disease in women over 35 who use OCP.

• Key points:
  • VTE risk: increased in women who use OCP, especially those with predisposing conditions
  • Smoking: increases the risk of thromboembolic disease in women over 35 who use OCP
  • Vaping: not directly mentioned in the label, but may be similar to smoking in terms of cardiovascular risk Based on the available information, it is unclear whether vaping increases the risk of VTE in women over 35 who use OCP. However, as a precautionary measure, women who vape and use OCP should be aware of the potential increased risk of thromboembolic disease and discuss their individual risk factors with their healthcare provider 2.

From the Research

Risks of Venous Thromboembolism (VTE) in Women Over 35 on OCP Who Vape

• The risk of VTE in women over 35 who use oral contraceptive pills (OCP) is a concern, as OCPs have been associated with an increased risk of VTE 3, 4, 5, 6, 7.
• However, the studies provided do not specifically address the risk of VTE in women who vape, as vaping is a relatively recent phenomenon and the studies cited are from earlier years.
• The risk of VTE is known to be increased in women who smoke, and it is possible that vaping may also increase this risk, although this is not explicitly stated in the provided studies.
• The use of OCPs is associated with an increased risk of VTE, particularly in women with other risk factors such as age over 35, smoking, and obesity 3, 4, 5, 6, 7.
• The type of progestin used in OCPs may also affect the risk of VTE, with some progestins being associated with a lower risk than others 4, 5.

Management Strategies for VTE in Women Over 35 on OCP Who Vape

• Women who use OCPs and vape should be informed of the potential risks of VTE and monitored for signs and symptoms of VTE 6.
• Healthcare professionals should consider the individual risk factors for VTE when prescribing OCPs to women over 35, including age, smoking status, and other medical conditions 3, 4, 5, 6, 7.
• The use of alternative contraceptive methods, such as progestin-only contraceptives or non-hormonal methods, may be considered for women who are at high risk of VTE 5.
• Women who experience symptoms of VTE, such as deep vein thrombosis or pulmonary embolism, should seek medical attention immediately 6.