Study Of Lybrel In Relation To Venous Thromboembolism

• deep vein thrombosis (DVT) [ Time Frame: 4.5 years ] [ Designated as safety issue: Yes ]
• pulmonary embolism (PE) [ Time Frame: 4.5 years ] [ Designated as safety issue: Yes ]
• cerebral venous sinus thrombosis (CVST) [ Time Frame: 4.5 years ] [ Designated as safety issue: Yes ]

• deep vein thrombosis (DVT) [ Time Frame: 2007-2012 ] [ Designated as safety issue: Yes ]
• pulmonary embolism (PE) [ Time Frame: 2007-2012 ] [ Designated as safety issue: Yes ]
• cerebral venous sinus thrombosis (CVST) [ Time Frame: 2007-2012 ] [ Designated as safety issue: Yes ]

Lybrel® is an oral contraceptive that delivers low doses of levonorgestrel and ethinyl estradiol (90 μg/20 μg). Lybrel is taken on a continuous basis without a placebo or pill-free interval to inhibit menstrual cycle bleeding by delivering a steady level of the 2 hormones for as long as the drug is used. Lybrel was marketed in the US in July of 2007. The objective of this database case-control study is to estimate the risk of idiopathic VTE (deep vein thrombosis and pulmonary embolism) in current users of Lybrel (ethinyl estradiol 20ug/levonorgestrel 90ug) compared to current users of other oral contraceptives containing 20μg of ethinyl estradiol.

The base population consists of all currently available data on current users (15-49 years old) of Lybrel and other oral contraceptives (OC) containing 20 µg ethinyl estradiol in the PharMetrics/IMS and MarketScan databases. From among the base population, the databases are then searched for any diagnosis of deep vein thrombosis (DVT), pulmonary embolism (PE), or cerebral venous sinus thrombosis (CVST) [referred to collectively as venous thromboembolism or VTE] that occurred after receipt of Lybrel or other oral contraceptives containing 20 µg ethinyl estradiol. The intent is to include newly diagnosed cases of VTE.

The base population for each year of the study will comprise all 15 - 49 year old women who have any recorded prescriptions for either continuous use ethinyl estradiol 20ug/levonorgestrel 90ug or a cyclic oral contraceptive that contains 20 µg ethinyl estradiol. The women are identified from PharMetrics and MarketScan databases. Additionally, women are enrolled if the index prescription is a new one; this is defined as a prescription dispensed following a 4-month window in which no combined hormonal contraception prescriptions were filled.

• Venous Thrombosis
• Pulmonary Embolism
• Sinus Thrombosis, Intracranial

• Drug: 90ug levonorgestrel / 20 ug ethinyl estradiol
  This is a non-interventional observational database study, thus no interventions are offered to patients in the study.
  Other Name: Lybrel
• Drug: Oral Contraceptives containing 20 ug of ethinyl estradiol
  This is a non-interventional observational database study, thus no interventions are offered to patients in the study.
  Other Name: Lessina, Aviane, Junel 1/20, Junel FE 1/20, Levlite, Lutera, Alesse, Loestrin FE 1/20, Loestrin 1/20, Microgestin 1/20, Microgestin FE 1/20

• Lybrel®
  Current users of 90 ug levonorgestrel / 20 ug ethinyl estradiol - cases and controls (i.e., women diagnosed with new venus thromboembolism [VTE] and women not diagnosed with VTE).
  Intervention: Drug: 90ug levonorgestrel / 20 ug ethinyl estradiol
• Other OCs containing 20μg of ethinyl estradiol
  Current users of oral contraceptives containing 20μg of ethinyl estradiol - cases and controls (i.e. women diagnosed with new VTE and women not diagnosed with VTE)
  Intervention: Drug: Oral Contraceptives containing 20 ug of ethinyl estradiol

Inclusion Criteria:

• New users of the study drugs (i.e., Lybrel and the comparison OCs)

Exclusion Criteria:

• No specific exclusion criteria for the base study cohort.