Bleeding issues in women prescribed anticoagulation

Abstract

Pre-menopausal women experience more bleeding complications when prescribed concurrent anticoagulant therapy relative to men. This increased propensity for bleeding is characterised predominantly by heavy menstrual bleeding and has been amplified since the emergence of the direct oral anticoagulants into clinical practice. Published research suggests that all Xa-inhibitors can cause this, and studies are underway to determine whether one is better over another.Experience from clinic suggests that women often accept heavy menstrual bleeding as a consequence of being prescribed anticoagulant therapy and so it is important at initiation and follow-up, that women are asked about the impact the anticoagulant therapy is having on the bleeding pattern of their menstrual cycle, and corrective action taken in appropriate cases. The optimum management of heavy menstrual bleeding in women prescribed anticoagulation therapy is not yet established and the studies underway, evaluating the incidence, severity and patient experience in this setting, are eagerly awaited.

Keywords

• Anticoagulants
• Menorrhagia
• Factor Xa inhibitors
• Women
• Coumarins