Peter Hannon, MD

Ryan KA, Cole JW, Saslow K, Mitchell BD, McArdle PF, Sparks MJ, et al. Prevention Opportunities for Oral Contraceptive–Associated Ischemic Stroke. Stroke. 2014

OCP use has long been known to have an association with increased stroke risk, especially in the setting of concurrent risk factors such as smoking.  Utilizing data from the Stroke-Prevention-in-Young-Women-Study, authors Ryan and colleagues re-investigated these associations, however with an additional focus on whether or not participants recall getting advice from physicians to not take OCPs due to their underlying stroke risk.  Exclusion criteria included being currently or recently pregnant, nursing, or being status-post hysterectomy or tubal ligation. After exclusion criteria, 224 young women ages 15-49 who suffered stoke and 348 matched controls were included in this study, and information was gathered using a standardized face-to-face interview. 

In line with previous studies, the authors found a high correlation with stroke in the setting of OCP use in the presence of one or more additional risk factors (OR=3.12; 95%CI=1.62-6.00), though this association was not found to be statistically significant in participants without additional risk factors.  Current smokers had the highest risk (OR 4.29), followed by those with headaches (OR 3.82). Of 256 women with one or more risk factors (99 cases, 157 controls), only 38% recalled being advised not to start an OCP and 36% recalled being told to stop based on their risk modifier profile. Interestingly, at the time of stroke or interview, 24% of those advised not to start OCPs and 15% of those advised to stop taking them were on oral contraceptives despite that advice. 

This study has some limitations, noted by authors, such as a small sample size and the significant potential of recall bias. However, this study does reaffirm known stroke risks with OCP use in the setting of additional risk-modifiers, and more importantly highlights the role that improved physician communication and counseling could play in helping to prevents OCP-related stroke. Clearly, the more we can do to educate our patients about potential stroke risks, the better.  For a significant portion of participants interviewed in this study at least, it appears that message is not being relayed effectively.