Prevention opportunities for oral contraceptive-associated ischemic stroke.

BACKGROUND AND PURPOSE Literature suggests a small increased risk of ischemic stroke with oral contraception (OC) use. We evaluated the association of stroke and OC use in women on the basis of whether they recalled being advised by a physician not to use OC or to discontinue OC use because of the presence of stroke risk modifiers, and whether such advice resulted in behavioral change. METHODS A total of 572 women (224 strokes and 348 controls) aged 15 to 49 years were interviewed about OC use and risk modifiers, including cigarette smoking and headaches, among others. RESULTS The adjusted odds ratio for OC use and stroke was 2.00 (95% confidence interval, 1.29-3.09). The association of OC use with stroke was stronger in women that reported receiving doctor's advice against OC use because of the presence of other stroke risk modifiers (odds ratio, 3.12; 95% confidence interval, 1.62-6.00) than in women who did not recall receiving such advice (odds ratio, 1.31; 95%confidence interval, 0.71-2.43). Of 256 women who recalled being advised by their doctor not to start OC or to discontinue OC use because of the presence of other stroke risk modifiers, 24% were still on OC at the time of stroke or interview. CONCLUSIONS We confirm that certain medical conditions increase the risk of stroke during OC use and demonstrate the importance of physician counseling in those using OC in the setting of concurrent high-risk conditions and the need for improved patient compliance with such counseling.