Risco de tromboembolismo venoso associado ao uso de contraceptivos orais combinados em mulheres em idade fértil: uma revisão crítica de evidências
Vigil Sanit Debate, Rio de Janeiro, 2026, v.14: e02481| Publicado em: 04/02/2026
DOI:
https://doi.org/10.22239/2317-269X.02481Palavras-chave:
Anticoncepcionais Orais Combinados, Tromboembolismo Venoso, Segurança do PacienteResumo
Introdução: O uso de anticoncepcionais orais combinados (COC) vem despertando preocupação quanto ao risco de tromboembolismo venoso (TEV) em mulheres em idade fértil. Geralmente eles contêm dois componentes: o estrogênio e uma variedade de progestágenos. Objetivo: Avaliar a segurança para TEV do uso de contraceptivos orais combinados em mulheres em idade fértil. Método: Revisão crítica de revisões sistemáticas (RS) com protocolo registrado na Open Science Framework, para responder ao objetivo de pesquisa. Resultados: Foram incluídas cinco RS. Brabaharan et al. (2022) encontraram um risco aumentado de TEV associado ao uso de COC contendo desogestrel em baixa dose, com tamanho do efeito de 2,05 (IC 95% 1,59–2,64). Wan-Lin Zhang et al. (2021) avaliaram COC com drospirenona (DRSP) em comparação com os que não continham DRSP (excluindo levonorgestrel), redução no risco de TEV, com hazard ratio (HR) ajustado de 0,76 (IC 95% 0,59–0,98). De Bastos et al. (2014) mostraram um risco aumentado de TEV ao comparar usuárias de COC com não usuárias: 1ª geração: razão de risco (RR) 3,2 (IC 95% 1,6–6,4); 2ª geração: RR 2,6 (IC 95% 1,5–4,7); 3ª geração: RR 3,5 (IC 95% 2,0–6,1). Stegeman et al. (2013), com estudo idêntico ao de De Bastos, mostraram risco relativo de 3,5 (IC 95% 2,9-4,3). A revisão de Peragallo Urrutia et al. (2013), odds ratio de 2,97 (IC 95% 2,46–3,59), ao comparar usuárias com não usuárias de COC. Conclusões: As evidências reunidas nas revisões sistemáticas analisadas indicam que o risco absoluto de TEV é baixo em mulheres jovens e saudáveis. No entanto, o risco relativo está presente especialmente com o uso de COC contendo estrogênio em doses mais altas ou progestágenos de 3ª e 4ª gerações. A influência de fatores de confusão como idade, índice de massa corporal e características individuais deve ser cuidadosamente considerada na interpretação dos dados.
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Biografia do Autor
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Erika Barbosa Camargo, Universidade do Distrito Federal (UnDF), Brasília, DF, Brasil | Programa de Evidências para Políticas e Tecnologias em Saúde (PEPT), Fundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brasil
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Viviane Cássia Pereira, Programa de Evidências para Políticas e Tecnologias em Saúde (PEPT), Fundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brasil
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Flávia Tavares Silva Elias, Programa de Evidências para Políticas e Tecnologias em Saúde (PEPT), Fundação Oswaldo Cruz (Fiocruz), Brasília, DF, Brasil
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