Скачать с ютуб Management of anticoagulant-associated heavy menstrual bleeding в хорошем качестве

Management of anticoagulant-associated heavy menstrual bleeding

Heavy menstrual bleeding (HMB), in clinical practice, refers to clinically excessive menstrual blood loss that interferes with a woman’s physical, social, emotional, and/or material quality of life. HMB affects approximately 10-35% of women but can be as common as 70% of women on oral anticoagulation. Oral anticoagulation can increase both the duration and the degree of menstrual bleeding. Observational data suggests that HMB might be more common among women on rivaroxaban or edoxaban as compared to apixaban, dabigatran or vitamin K antagonists (VKAs). HMB can result in iron deficiency anemia, can have a significant psychosocial impact on women and frequently goes unrecognized among anticoagulated women. Symptoms surrounding HMB should be elicited at the first visit, prior to prescribing anticoagulation. Premenopausal women should be made aware that HMB may occur upon starting anticoagulation therapy and should be encouraged to discuss HMB with their physician if it occurs. Both hormonal contraceptives and antifibrinolytic therapy can be used to reduce oral anticoagulant-associated HMB. Temporary interruption of anticoagulation during menstrual bleeding should be avoided as it has been associated with an increased risk of recurrent VTE. Rotation of anticoagulation to an alternative agent, such as apixaban or dabigatran, can be considered. Procedural interventions, such as endometrial ablation or uterine artery embolization, may rarely be required. Referral to a gynecologist is warranted when a specific etiology is suspected for which targeted management is required. This presentation is by Dr Joseph Shaw from the 2021 Thrombosis Canada annual conference.