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QUESTION: Is oral contraceptive use associated with an increased risk for ischaemic stroke?
Studies published from January 1960 to November 1999 were identified by searching Index Medicus, Medline, BIOSIS, and Dissertation Abstracts Online with the terms oral contraceptives, stroke, estrogen, cerebral, ischemia, thrombosis, and venous sinus. Textbooks, foreign language articles, and bibliographies of relevant papers were reviewed, and content experts were contacted.
Studies were included that had >10 cases of ischaemic stroke or cerebral venous sinus thrombosis, a clear differentiation of ischaemic and hemorrhagic stroke, a cohort or case control design with control patients gathered within 2 years of stroke, sufficient data to compare oral contraceptive use with non-use, a design or analysis that controlled for age, and no later publication of identical data.
Data were extracted on study region; follow up or refusal …
Sources of funding: National Stroke Association and National Institutes of Health.
For correspondence: Dr S C Johnston, Department of Neurology, Box 011, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0114, USA. Fax +1 415 476 3428.