Disparities in menstrual bleeding management during acute venous thromboembolism treatment: A review of UK practice and a call for clinical studies
Eman Hassan a) b), David Sutton c), Richard J Buka a), Gillian Lowe a) b), Taran Nandra d), Nkemdirim Jacob e), Lucy Rose f), Yasir Alhamdi f), HaemSTAR Collaborators, Phillip L.R. Nicolson a) b)
a) Department of Cardiovascular Sciences, College of Medicine and Health, University of Birmingham, B15 2TT, United Kingdom of Great Britain and Northern Ireland
b) Department of Haematology, Queen Elizabeth Hospital, Birmingham B15 2TH, United Kingdom of Great Britain and Northern Ireland
c) Department of Haematology, University Hospitals of North Midlands, ST4 6QG, United Kingdom of Great Britain and Northern Ireland
d) Department of Haematology, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom of Great Britain and Northern Ireland
e) Royal Hospital for Children, Glasgow, United Kingdom of Great Britain and Northern Ireland
f) Department of Haematology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, United Kingdom of Great Britain and Northern Ireland
Abstract
Background
Heavy menstrual bleeding (HMB) is a significant clinical burden for premenopausal individuals treated with anticoagulation for acute venous thromboembolism (VTE). Despite its prevalence, HMB management remains poorly studied, with wide variation in clinical practice.
Objectives
The current study aimed to explore current UK practices in managing HMB in anticoagulated individuals and identify areas requiring clinical research to address disparities.
Methods
A national survey was conducted among haematology consultants and consultant clinical pharmacists managing anticoagulated patients. The survey focused on management strategies, including anticoagulant selection, use of tranexamic acid (TXA), contraceptive options, and anticoagulation interruption.
Results and conclusion
Responses were collected from 102 participants, across the UK. Apixaban was the preferred anticoagulant for patients with HMB, followed by LMWH then dabigatran. Timing of TXA initiation varied widely between respondents, with (35.3 %) prescribing it any time after anticoagulation initiation, (11.8 %) delaying TXA use for 3 months, and (7.8 %) would not give it at all. (47.1 %) of respondents advise to discontinue oestrogen containing contraceptives in patients with acute VTE. Almost all respondents never or rarely stop anticoagulation for a patient with HMB and recent VTE ≤4 weeks. (62.7 %) of respondents showed their willingness to participate in clinical studies to study TXA use in the setting of acute VTE ≤4 weeks in anticoagulated individuals.
This study highlights significant variations in HMB management during anticoagulation for acute VTE. Disparities raise concerns about health inequities and underscore the urgent need for prospective clinical trials to improve patient outcomes.