Stroke and Etonogestrel/Ethinyl Estradiol Ring (NuvaRing): Clinical, Radiological, and Prognostic Features. (P2.012)

Background A recent, population-based epidemiologic study found Nuvaring (a vaginal contraceptive ring containing 15 µg ethinyl estradiol and 120 µg etonogestrel) has 2.5 times an increased relative risk of thrombotic stroke compared to non-use. Objective: There have been few details of the types and features of stroke associated with NuvaRing. We studied a case series of 19 such patients to clarify clinical and radiological features. Methods: Medical records and imaging for 18 cases were initially systematically reviewed (SRL) through consultation with a law firm involved in a class action suit. One case was seen personally (SRL) as a referred patient outside of litigation. All 19 cases were entered into a database detailing clinical, radiological, and prognostic features as well as other potential risk factors. Results: Average age at stroke was 31.7± 9.8 years; average duration of Nuvaring use prior to stroke was 11.2 months. Arterial stroke occurred in 9/19 (47%) - 1/9 (11%) was hemorrhagic. Venous sinus thrombosis was present in 10/19 (52%) on initial imaging - 7/10 (70%) were hemorrhagic. The most common presenting symptom was headache 11/19 (58%) followed by motor weakness in 6/19 (32%). A hypercoagulable condition was present in 3/19 (16%); 3/19 (16%) had history of hypercoagulable disease in a first-degree relative. Four of 19 (21%) had BP >130/89 at the time of stroke; 4/19 (21%) had history of stroke in a first-degree relative. Six (32%) had history of migraine; 2 (10%) were post-partum and 1 (0.5%) had atrial fibrillation. Mortality was 0.5%; 8/19 (42%) fully recovered and 3/19 (15%) were discharged to rehabilitation. Conclusions: In this largest case series of NuvaRing associated stroke to date, approximately half of the strokes are venous and half are arterial. Stroke typically occurred within the first year of use, and as soon as 2 weeks after NuvaRing initiation. Disclosure: Dr. Piran has nothing to disclose. Dr. Balucani has nothing to disclose. Dr. Tark has nothing to disclose. Dr. Adler has nothing to disclose. Dr. Levine has received personal compensation in an editorial capacity for MedLink. Dr. Levine has received royalty payments as editor of a book.