Incidence and impact of anticoagulation-associated abnormal menstrual bleeding in women after venous thromboembolism

Author(s): C.M.M. de Jong1; M. Blondon2; C. Ay3; A. Buchmuller4; J. Beyer-Westendorf5; J. Biechele6; L. Bertoletti4,7; G. Colombo8; M.P. Donadini9; S.V. Hendriks1; L. Jara-Palomares10,11; S. Nopp3; P. Ruiz-Artacho12; P. Stephan13; C. Tromeur13; T. Vanassche14; P.E. Westerweel15; F.A. Klok1 for the TEAM-VTE investigators
Source: Blood (2022) 140 (16): 1764–1773
Maem Hussein MD

Dr. Maen Hussein's Thoughts

A benign hematology article, not a large study but an eye opener.


Preliminary data and clinical experience have suggested an increased risk of abnormal uterine bleeding (AUB) in women of reproductive age treated with anticoagulants, but solid data are lacking. The TEAM-VTE study was an international multicenter prospective cohort study in women aged 18 to 50 years diagnosed with acute venous thromboembolism (VTE). Menstrual blood loss was measured by pictorial blood loss assessment charts at baseline for the last menstrual cycle before VTE diagnosis and prospectively for each cycle during 3 to 6 months of follow-up. AUB was defined as an increased score on the pictorial blood loss assessment chart (>100 or >150) or self-reported AUB. AUB-related quality of life (QoL) was assessed at baseline and the end of follow-up using the Menstrual Bleeding Questionnaire. The study was terminated early because of slow recruitment attributable to the COVID-19 pandemic. Of the 98 women, 65 (66%) met at least one of the 3 definitions of AUB during follow-up (95% confidence interval [CI], 57%-75%). AUB occurred in 60% of women (36 of 60) without AUB before VTE diagnosis (new-onset AUB; 95% CI, 47%-71%). Overall, QoL decreased over time, with a mean Menstrual Bleeding Questionnaire score increase of 5.1 points (95% CI, 2.2-7.9), but this decrease in QoL was observed only among women with new-onset AUB. To conclude, 2 of every 3 women who start anticoagulation for acute VTE experience AUB, with a considerable negative impact on QoL. These findings should be a call to action to increase awareness and provide evidence-based strategies to prevent and treat AUB in this setting. This was an academic study registered at as #NCT04748393; no funding was received.

Author Affiliations

1Department of Medicine–Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands; 2Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; 3Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria; 4Service de Médecine Vasculaire et Thérapeutique, INSERM, Centre d’Investigation Clinique 1408, Investigation Network on Venous Thrombo-Embolism, Centre Hospitalier Universitaire (CHU) de St-Etienne, Saint-Etienne, France; 5Division of Hematology and Hemostasis, Department of Medicine I, University Hospital Carl Gustav Carus, Dresden, Germany; 6Department of Angiology, Universitätsspital Basel, Basel, Switzerland; 7INSERM, Unité Mixte de Recherche (UMR) 1059, Université Jean-Monnet, Saint-Etienne, France; 8Research Centre on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese, Italy; 9Department of Medicine and Surgery, Research Centre on Thromboembolic Disorders and Antithrombotic Therapies, University of Insubria, Varese, Italy; 10Medical Surgical Unit of Respiratory Diseases, Virgen del Rocio Hospital, Seville, Spain; 11Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain; 12Department of Internal Medicine, Clínica Universidad de Navarra, Madrid, Spain; 13Department of Internal Medicine and Chest Diseases, Groupe d’Etude de la Thrombose de Bretagne Occidentale, UMR 1304, Centre Hospitalier Universitaire (CHU) de Brest, Brest, France; 14Department of Cardiovascular Sciences, University Hospital Leuven, Leuven, Belgium; 15Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands

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