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Journal update monthly top five
  1. Mohammed Hamza1,
  2. Orla Kelly1,
  3. Conor O'Gara1,
  4. Paula Cuddihy1,
  5. Máire Bourke1,
  6. Maria Angela Garcia Cadena1,
  7. Geraldine McMahon1,
  8. Daniel Darbyshire2,3
  1. 1 Emergency Department, St James's Hospital, Dublin, Ireland
  2. 2 Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
  3. 3 Emergency Department, Salford Royal Hospitals NHS Trust, Salford, UK
  1. Correspondence to Dr Mohammed Hamza, Emergency Department, St James's Hospital, Dublin 8, Ireland; mohammed.hamza{at}

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This month’s update is by the St James’ Hospital, Dublin team. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlighted the main findings, key limitations and clinical bottom line for each paper.

The papers are ranked as:

  • Worth a peek—interesting, but not yet ready for prime time.

  • Head turner—new concepts.

  • Game changer—this paper could/should change practice.

Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study by Meaidi et al

Topic: venous thromboembolism

Outcome rating: game changer

Both non-steroidal anti-inflammatory drug (NSAID) and hormonal contraception use have individually been associated with an increased risk of venous thromboembolism (VTE). However, there is little research on the risk of concomitant use.1

This nationwide retrospective cohort study followed women between the ages of 15 and 49 living in Denmark between 1996 and 2017 using different national registries and individual personal identification numbers. Hormonal contraception was categorised into high, medium and low risk according to the dose. Incidence rates adjusted for age, calendar time, educational level, hypertension, diabetes, polycystic ovary syndrome, endometriosis, migraine, systemic connective tissue disorders and inflammatory polyarthropathies. NSAID use was based on purchase. Patients with cancer or undergoing cancer treatment, thrombophilia or who emigrated or died were excluded. Surrogate adjustments were made for missing data, for example, using educational attainment as an indicator of obesity and smoking.

More than 2 million women and almost 21 million person-years were included. Hormonal contraception and concomitant NSAID use were observed in 5 29 704 women. The absolute risk of VTE in the first week after NSAID purchase in women on hormonal contraception was 0.02%. The use of NSAIDS was associated with an adjusted IRR of VTE of 7.2 (6.0–8.5) among those without hormonal contraception, 11.0 (9.6–12.6) among those using high-risk hormonal contraception, 7.9 (5.9–10.6) among those taking medium-risk …

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  • Twitter @MoHamza89

  • Contributors Format devised and provided by Charles Reynard, Anisa Jafar, DD, Govind Oliver, Gabrielle Prager and Simon Carley. MH reviewed the included studies and wrote the manuscript with help from OK, CO'G, MB, PC and MAGC. GM, Gabrielle Prager, DD and Ellen Weber provided critical feedback and suggested edits to the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.