Yasmin and venous thromboembolism (VTE)

• a review revealed (1) "..risk of venous thromboembolic embolism (VTE) associated with use of Yasmin does not appear to differ from that associated with use of comparator COCs (levonorgestrel COCs and other COCs)...Yasmin is an option for those women suitable for a COC. However, current evidence indicates that on a population level Yasmin has no conclusive advantages over other standard strength COCs..."
• some more recent studies suggest that the risk of venous thromboembolism (VTE) in association with use of the combined oral contraceptive Yasmin may be slightly higher than previously estimated, and somewhere between the risk associated with combined pills containing levonorgestrel (otherwise known as 'second generation') and those containing desogestrel or gestodene (known as 'third generation') (2)
  • however, the risk of VTE with Yasmin remains very small and, like other oral contraceptives, is less than that associated with pregnancy

Advice for prescribers (2)

• the risk of a venous thrombosis in women who use Yasmin, as for all combined oral contraceptive pills, is smaller than the risk of VTE associated with pregnancy
  
  
• evidence suggests that the risk of VTE in association with Yasmin may be slightly higher than previously estimated, and somewhere between that for levonorgestrel-containing pills and that for desogestrel or gestodene-containing pills
  
  
• any prescribing decision should take into account each woman’s personal risk factors and any contraindications
  
  
• all combined oral contraceptives, including Yasmin, should be prescribed with caution to obese women (BMI >30), or those with a higher baseline risk of VTE for other reasons
  
  
• all hormonal contraceptives are highly effective and safe and have important health benefits, including those from avoiding unplanned pregnancy. When used appropriately, the benefits of all combined oral contraceptives far outweigh the risk of VTE, which is rare

The BNF, individual Summaries of Product Characteristics (available at www.medicines.org.uk) and the UK Medical Eligibility Criteria (UKMEC) for contraceptive use should be consulted for further information, including when a combined hormonal contraceptive would be absolutely contraindicated, and when expert clinical judgement and/or referral to a specialist contraceptive provider is necessary.

Reference:

1. MeReC Bulletin (2006); 17(2):1-9.
2. MHRA: April 2010 Drug Safety Update