Since the first reports in 2016, Nexplanon has been the subject of close monitoring. If the preventive measures have significantly reduced the number of incidents, migration continue to be reported. The ANSM specifies the driving to be held in the face of these cases.
Reinforced monitoring since 2016
It was in 2016 that the first migration reports of the Nexplanon implant in the pulmonary artery appeared. Following these alerts, the National Medicines Safety Agency strengthened national and European surveillance. As she indicates: “First reports of pharmacovigilance migration of this implant in the pulmonary artery have been reported“”.
In 2020, a full prevention system was deployed by the “Medication Agency: Information campaigns, training of health professionals at the installation and withdrawal of the implant, creation of expertise centers … The objective was to avoid too deep insertions which could lead to a passage from the implant in the blood circulation. Results:”The balance sheet presented during the Permanent Surveillance and Pharmacovigilance Scientific Committee of June 2024 lists 68 cases of migration of the system in the pulmonary artery declared between 2001, date of its marketing in France, and on December 31, 2023. The rate of impact of cases notified according to the date of integration of the implant (2020/2023 versus 2013/2019) is approximate risk reduction in January 2020 (from 2.60 to 0.73 /100,000 implants sold)“.
An assessment that suggests a positive impact of the actions implemented by the ANSM, even if the risk persists.
A reduced risk, but always existing
To date, around 68 cases of migration of the implant in the pulmonary artery have been reported in France between 2001 and December 2023. These incidents remain extremely rare – the equivalent of 3 cases per 100,000 poses – but can cause serious complications such as chest pain, respiratory disorders or require heavy surgical acts.
How do I know if the implant has migrated?
- People carrying an implant must check regularly (1 to 2 times a month) that the implant is still in place under the skin. If the implant is no longer palpable or seems to have moved, it is important to quickly consult a healthcare professional.
- Likewise, if an implant person has symptoms evocative of a pulmonary migration: chest pain and/or breathing difficulties, cough, sometimes with blood in spit (hemoptysis), they must consult a doctor.
A care now better supervised
In addition, the management of implants that have migrated in the pulmonary artery is a complex procedure which requires specialized consultation with a vascular and thoracic surgeon. The withdrawal decision must be made collegially by a multidisciplinary team evaluating the benefit-risk report of an intervention. In June 2025, the ANSM published new recommendations intended to supervise the management of migration caseswritten in collaboration with the Professional National Council for Thoracic and Cardio-Vascular Surgery (CNP-CTCV), the French Société de Surgery thoracique and Cardio-Vascular (SFCTCV), and the Regional Pharmacovigilance Center (CRPV) in Tours.
These recommendations specify the driving to be taken in the event of confirmed migration. The endovascular track, made in an interventional radiology center, is to be favored to extract the implant without open surgery. If the implant is too deep or inaccessible by this method, thoracic surgery may be necessary, by thoracoscopy or even thoracotomy.
Prevention remains essential. ANSM recalls that patients must regularly palpates their implant. In the absence of palpation, an ultrasound is quickly essential, supplemented if necessary by a radiography or a thoracic scanner. Doctors and patients must act without delay to avoid any complications.