目的:阐明雌激素剂量和偏头痛史(包括偏头痛亚型)等因素如何影响与联合使用激素避孕药(CHC)相关的缺血性卒中风险。
背景:由于对卒中风险的担忧,CHC在有先兆偏头痛患者中的使用受到限制。
方法:我们对大型三级护理中心的CHC使用者中与雌激素剂量和偏头痛史相关的卒中风险进行了病例对照分析。确定了所有在2010年1月1日至2019年12月31日期间使用CHC的18-55岁女性。使用ICD代码识别出患有中风的患者,并通过图表和影像学检查进行确认。个人和家族病史的细节,中风评估,乙炔雌二醇剂量(EE;≥30vs.<30μg),和人口统计数据被收集。从20,000名没有中风的CHC用户的随机样本中,根据患者特征确定并匹配对照组(n=635),医疗和家族史,以及中风的危险因素,为了评估偏头痛诊断之间的关联,偏头痛亚型,雌激素剂量,和中风。
结果:在我们队列中的203,853名CHC用户中,127例确诊中风(0.06%;CI0.05%,0.07%)。在未经调整的分析中,与对照组(109/635,17.2%;p=0.011)相比,病例队列中诊断为偏头痛的患者数量较多(34/127,26.8%).与使用<30μg剂量的患者相比,≥30μgEE剂量的患者中风风险更高(OR,1.52;CI1.02,2.26;p=0.040)。与没有偏头痛相比,偏头痛的个人病史增加了中风的几率(或,2.00;CI1.27,3.17;p=0.003)。与没有偏头痛相比,有先兆偏头痛患者的卒中风险没有显著增加,但是没有先兆的偏头痛增加了风险(或者,2.35;CI1.32,4.2;p=0.004)。
结论:我们的CHC使用者队列中的总体卒中风险较低。当CHC用于偏头痛患者时,优选含有≤30μgEE的制剂。共同决策应包括讨论偏头痛患者的缺血性卒中风险,即使是那些没有光环的人。
To clarify how factors such as estrogen dose and migraine history (including migraine subtype) impact ischemic stroke risks associated with combined hormonal contraceptive (CHC) use.
CHC use in those with migraine with aura has been restricted due to concerns about stroke risk.
We conducted a case-control analysis of stroke risk associated with estrogen dose and migraine history among CHC users in a large tertiary care center. All women aged 18-55 who used a CHC between January 1, 2010, and December 31, 2019, were identified. Those with a stroke diagnosis were identified using ICD codes and confirmed via chart and imaging review. Details of personal and family medical history, stroke evaluation, ethinyl estradiol dosing (EE; ≥30 vs. <30 μg), and demographics were collected. From a random sample of 20,000 CHC users without stroke, a control cohort (n = 635) was identified and matched based on patient characteristics, medical and family histories, as well as stroke risk factors, to assess association between migraine diagnosis, migraine subtype, estrogen dose, and stroke.
Of the 203,853 CHC users in our cohort, 127 had confirmed stroke (0.06%; CI 0.05%, 0.07%). In unadjusted analyses, a higher number of patients in the case cohort had a diagnosis of migraine (34/127, 26.8%) compared to controls (109/635, 17.2%; p = 0.011). Stroke risk was higher with ≥30-μg EE doses compared to those using a <30-μg dose (OR, 1.52; CI 1.02, 2.26; p = 0.040). Compared to no migraine, personal history of migraine increased the odds of stroke (OR, 2.00; CI 1.27, 3.17; p = 0.003). Compared to no migraine, stroke risk was not significantly increased in those with migraine with aura, but migraine without aura increased the risk (OR, 2.35; CI 1.32, 4.2; p = 0.004).
Overall stroke risk in our cohort of CHC users was low. When CHCs are used in those with migraine, formulations containing ≤30 μg EE are preferred. Shared decision-making should include discussions about ischemic stroke risks in patients with migraine, even those without aura.