Most women who take anticoagulants for blood clots experience abnormal menstrual bleeding
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Two-thirds of women of child-bearing age who began taking anticoagulants for acute venous thromboembolism had abnormally heavy menstrual bleeding in the months that followed therapy initiation, according to data from a prospective study.
Results of the analysis, published in Blood, also showed women with heavier bleeding after taking anticoagulants experienced diminished quality of life.
Background
Many women have abnormal uterine bleeding, but incidence among reproductively active women who receive anticoagulants is even higher, according to Cindy M.M. de Jong, MD, a PhD student in the department of medicine, thrombosis and hemostasis at Leiden University Medical Center in the Netherlands.
“Exact estimations of the incidence, prevalence and impact of anticoagulation-induced abnormal menstrual bleeding remain unavailable,” she told Healio. “To quantify the burden of abnormal uterine bleeding in women subjected to anticoagulant therapy, we conducted this study to acquire high-quality prospective data on [its] incidence, prevalence and relevance in women starting anticoagulant therapy because of acute venous thromboembolism.”
Methodology
The prospective, multicenter TEAM-VTE study included 98 women (mean age, 34 ± 9.4 years) aged 18 to 50 with VTE who had active menstrual cycles.
Overall incidence of abnormal uterine bleeding and incidence of new-onset abnormal menstrual bleeding served as the study’s primary outcomes. Secondary outcomes included changes in quality of life associated with abnormal menstrual bleeding.
Investigators measured blood loss using Pictorial Blood Loss Assessment Charts (PBAC) for each woman’s last menstrual cycle before diagnosis of VTE and for each subsequent menstrual cycle during the 3- to 6-month follow-up period. The analysis determined abnormal uterine bleeding as being self-reported or using elevated PBAC scores greater than 100 or greater than 150.
Researchers also evaluated quality-of-life scores related to abnormal uterine bleeding at baseline and at the end of the study’s follow-up period using the Menstrual Bleeding Questionnaire (MBQ).
The investigators terminated the study early due to slow enrollment during the COVID-19 pandemic.
Key findings
Results showed 65 (95% CI, 57-75) of 98 women (66%) met the definition of abnormal uterine bleeding during the study’s follow-up period.
In addition, 36 (95% CI, 47-71) of 60 women (60%) had new-onset abnormal uterine bleeding that occurred for the first time after diagnosis and the start of treatment for VTE.
Investigators identified a significant decrease in quality-of-life scores among women with abnormal uterine bleeding, with a mean increase in MBQ score of 5.1 points (95% CI, 2.2-7.9) between baseline evaluation and the end of anticoagulation therapy or 6-month follow-up visit.
This decrease in quality-of-life scores only occurred in women with new-onset abnormal uterine bleeding, the researchers noted.
Clinical implications
The study results suggest incidence of abnormal uterine bleeding is high among women of reproductive age undergoing anticoagulant therapy, de Jong said.
“These findings should be a call to action to increase awareness of [abnormal uterine bleeding] in patients undergoing anticoagulant therapy,” she told Healio.
“These findings highlight the critical need to incorporate assessment of [abnormal uterine bleeding] in daily practice, because of its impact and easily available treatment options,” de Jong added. “VTE caretakers should be aware of this, take appropriate action to routinely assess menstrual blood loss in all women with a new VTE diagnosis and adequately treat incident [abnormal uterine bleeding].”
For more information :
Cindy M.M. de Jong, MD, can be reached at Department of Medicine, Thrombosis and Hemostasis, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands; email: c.m.m.de_jong@lumc.nl.
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