Subarachnoid Hemorrhage

A recent systematic review of the risk factors for subarachnoid hemorrhage (SAH) shows that smoking doubles the risk for SAH (Feigin et al., 2005). About one third of all SAH was found to be attributable to smoking in a smaller case-control study, and, although the risk dropped within a few years after quitting, it may remain increased for up to 15 years in the heaviest women smokers (Anderson et al., 2004).

Older studies involving high-dose estrogen OCs showed a significant interaction with smoking, increasing the risk for stroke and SAH among women who both smoked and used OCs. Studies of women who use second and third-generation OCs find no increased risk of stroke, even among smokers (Yang et al., 2009). However, the American College of Obstetricians and Gynecologists states that "practitioners should prescribe combination hormonal contraceptives with caution, if at all, to women older than 35 years who smoke" (ACOG, 2006).

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