Thrombosis risk with different COCs

A very useful review and meta-analysis in the BMJ has grouped COCs with regard to their relative risk of thromboembolism. Highest risk, unsurprisingly, is Ovran, which I can’t recall ever actually using. Of the ones in more common use, the risk levels broke down fairly approximately into two groups; I list them below with the brand names of each pill. Where more than one brand exists for each pill, I’ve done my best to arrange them in order of the cost at time of writing (though cannot vouch for the accuracy of this). (All COCs, of course, carry at least some increased risk over baseline.)

Lower risk

  • 20 mcg EE + levonorgestrel:
  • 30 mcg EE + levonorgestrel: Rigevidon, Microgynon 30, Levest, Ovranette
  • 20 mcg EE + gestodene: Femodette, Millinette 20/75, Sunya 20/75
  • 35 mg EE + norgestimate: Cilest

Higher risk

  • 30 mcg EE + gestodene: Femodene, Katya 30/75, Millinette 30/75
  • 20 mcg EE + desogestrel: Gedarel 20/150, Mercilon
  • 30 mcg EE + desogestrel: Gedarel 30/150, Marvelon
  • 35 mcg EE + cyproterone acetate: Dianette
  • 30 mcg EE + drosperinone: Yasmin

Interestingly, Dianette didn’t appear to be any lower risk than Yasmin in this study, and marginally lower risk than Marvelon although that didn’t look like a significant difference from the CIs.

OK, interesting. So, levonorgestrel/norgestimate good. Desogestrel/cyproterone/drosperinone bad. Gestodene, heavily dependent on associated oestrogen dose. (My extremely simplistic and no doubt leaving-out-a-million-factors notes.)

(BMJ 2013;347:f5298)


About Dr Sarah

I'm a GP with a husband and two young children.
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