OC 52.2 - Risk and impact of anticoagulation-associated abnormal menstrual bleeding in women of reproductive age with venous thromboembolism – the TEAM-VTE study

Tuesday, July 12, 2022

11:00 AM – 11:15 AM

Location: ExCel Center, S11B

Presentation Format: In-Person

Presenting Author(s)

Cindy MM De Jong, MD

MD, PhD student
Department of Medicine - Thrombosis & Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

MB

M Blondon

MD, PhD
Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine
Geneva, Geneve, Switzerland
Cihan Ay, MD

Professor, Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
AB

Andrea Buchmuller

Researcher
Centre d’Investigation Clinique 1408, INSERM, Centre Hospitalier Universitaire, Saint Etienne, France
Saint-Etienne, Rhone-Alpes, France
JB

Jan Beyer-Westendorf

MD, Head of Division of Thrombosis & Hemostasis
Department of Medicine 1, Division of Thrombosis & Hemostasis, Dresden University Clinic, Dresden, Germany
Dresden, Sachsen, Germany
JB

J Biechele

MD, PhD
Department of Oncology and Internal Medicine, Klinik Arlesheim
Arlesheim, Basel-Landschaft, Switzerland
Laurent Bertoletti, MD, PhD

MD, PhD
Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalo-Universitaire de Saint-Etienne ; INSERM CIC 1408 CHU de St-Etienne; INSERM UMR 1059, Université Jean Monnet, Saint-Etienne ; FCRIN INNOVTE, France.
Saint-Etienne, Rhone-Alpes, France
GC

G Colombo

Research Centre on Thromboembolic Disorders and Antithrombotic Therapies
University of Insubria
Varese, Lombardia, Italy
MD

Marco P. Donadini

Associate Professor
University of Insubria
Varese, Lombardia, Italy
SH

SV Hendriks

MD
Department of Thrombosis and Hemostasis, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
LJ

Luis Jara-Palomares

Senior consultant
Hospital Universitario Virgen del Rocío, Seville, Spain
Sevilla, Andalucia, Spain
Stephan Nopp, MD

PhD Student
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
PR

P Ruiz-Artacho

MD, PhD
Department of Internal Medicine, Clínica Universidad de Navarra
Madrid, Madrid, Spain
PS

P Stephan

Attachée de recherche clinique hospitalier
Department of Internal Medicine and Chest Diseases, CHU de Brest
Brest, Bretagne, France
CT

Cecile Tromeur

MD, PhD
Centre Hospitalo-Universitaire de Brest, Département de Médecine Interne et Pneumologie, INSERM U1304, CIC INSERM 1412, Univ_Brest, Brest, FCRIN INNOVTE, France.
Brest, Bretagne, France
Thomas Vanassche, MD PhD

MD, PhD
University Hospitals Leuven, Belgium
Leuven, Vlaams-Brabant, Belgium
PW

PE Westerweel

MD, PhD
Department of Internal Medicine, Albert Schweitzer Hospital
Dordrecht, Zuid-Holland, Netherlands
Frederikus A. Klok, MD, PhD

MD, PhD
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
Leiden, Zuid-Holland, Netherlands

Background: Women of reproductive age treated with anticoagulants have an increased risk of abnormal uterine bleeding (AUB). However, solid studies to quantify the prevalence of AUB are lacking.

Aims: To assess the incidence of (new-onset) AUB and impact on quality of life (QoL).

Methods: The TEAM-VTE study was an international, multicenter, prospective cohort study. Women aged 18-50 years treated with anticoagulants for venous thromboembolism (VTE) were included within one month after VTE diagnosis, before the next menstrual cycle, in 12 hospitals between August 2018 and September 2021. The study was terminated early because of slow recruitment due to the pandemic. Menstrual blood loss was measured by pictorial blood loss assessment charts (PBAC) at baseline for the last menstrual cycle before VTE diagnosis, and prospectively for each cycle during 3-6 month follow-up. AUB was defined according to three definitions: PBAC score >100, PBAC score >150, or self-reported increased menstrual volume. AUB-related QoL was assessed at baseline and end of follow-up using the Menstrual Bleeding Questionnaire (MBQ; higher scores indicate worse outcome).

Results: Of the 98 women (mean age: 34 years), 66% (65/98) met at least one of the three definitions of AUB during follow-up (95% confidence interval (CI) 57-75%; Table 1). AUB occurred in 60% (36/60) of women without AUB before VTE diagnosis (95%CI 47-71%). Overall, QoL decreased significantly over time with a mean increase in MBQ score of 5.1 points (95%CI 2.2-7.9). When stratifying by AUB, this decrease in quality of life was only observed among women who had new-onset AUB during the follow-up (Figure 1).

Conclusion(s): Two out of three women who start anticoagulation for acute VTE suffer from AUB, with a considerable negative impact on QoL. These findings should be a call to action to increase awareness for this issue and to provide evidence-based strategies for preventing and treating AUB in this setting.