Blood Loss in Women of Childbearing Potential Taking Oral Anticoagulants for Venous Thromboembolism (The BLEED Study)

Abstract

Background

Oral anticoagulants (OAC) may exacerbate menstrual bleeding in women of childbearing age; however, the existing literature on this issue has several limitations.

Materials and Methods

This study investigates abnormal uterine bleeding in women of childbearing age taking OAC–vitamin K antagonists or direct oral anticoagulants–for venous thromboembolism through a retrospective analysis of prospectively collected data. Uterine bleeding was assessed using the Pictorial Blood Assessment Chart (PBAC) and hemoglobin (Hb) values during anticoagulation compared with prior therapy. The number of unplanned medical visits for bleeding complications was also calculated.

Results

From June 2014 to November 2023, 110 women were recruited (median age, 36 years). PBAC scores correlated with Hb values at baseline and during therapy (analysis of variance [ANOVA], p < 0.01), with a significant difference in Hb values before and during anticoagulant therapy (delta Hb) among groups (ANOVA, p.0.034). Seventeen women (15.5%) reported uterine fibroids, experiencing a greater reduction in Hb values during anticoagulant administration than women without uterine fibroids (delta 0.3, interquartile range [IQR]: 0.8, 2.9 vs. 0.5, IQR 1.2, 0.3; p.0.012). Women with selfreported uterine fibroids required more frequent unplanned medical consultations for bleeding (mean visits 5 vs. 4, respectively; Poisson regression, p < 0.05). Among women with uterine fibroids, those taking apixaban showed smaller Hb changes than those on other oral anticoagulants (ANOVA, p.0.047). This difference persisted even after adjusting for potential confounders (multiple ANOVA, p.0.004).

Conclusion

Women of childbearing age taking OAC frequently experience changes in Hb values and PBAC scores during treatment, with uterine fibroids playing a significant role.

Keywords

childbearing age - abnormal uterine bleeding - oral anticoagulants - uterine fibroids

Note

Some data from the present study were accepted for oral presentation at ISTH 2024 conference (Bangkok, Thailand).

Data Availability Statement

Data will be made available to the editors of the journal for review or query upon request.

Publication History

Received: 26 July 2024

Accepted: 05 November 2024

Accepted Manuscript online:
06 November 2024

Article published online:
21 November 2024

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