title: Uterine bleeding during anticoagulation in women with venous thromboembolism.
abstract: BACKGROUND
  Women presenting with uterine bleeding during the course of anticoagulant therapy for venous thromboembolism (VTE) present a difficult therapeutic dilemma due to the absence of evidence-based recommendations.
  
  
  METHODS
  We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the clinical characteristics of women presenting with uterine bleeding during anticoagulation for VTE, its frequency, time course, management and 30-day outcomes.
  
  
  RESULTS
  As of October 2016, 31,951 women with VTE were recruited in RIETE. During the course of anticoagulant therapy, 53 (0.17%) developed major uterine bleeding, 118 (0.37%) non-major uterine bleeding and 948 (2.97%) had major bleeding in other sites. Median time elapsed from VTE to bleeding was: 32, 71 and 22 days, respectively. Mean age was: 56±17, 52±20 and 75±14 years, respectively. Women with major uterine bleeding more likely had cancer (51%), anemia (72%), raised platelet count (19%) or recent major bleeding (11%) at VTE presentation than those in the other subgroups. During the first 30 days after bleeding, 17%, 1.7% and 31% of women died, respectively. Of 11 women with uterine bleeding who died, 9 (82%) had cancer, two (18%) died of bleeding and one (9.1%) died of pulmonary embolism after discontinuing anticoagulation.
  
  
  CONCLUSIONS
  Uterine bleeding during the course of anticoagulation for VTE is not uncommon and mostly affects young women. Those with cancer, anaemia, raised platelet count or recent bleeding at baseline are at an increased risk for uterine bleeding during anticoagulation.
authors.affiliation: Department of Emergency, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. Electronic address: fmoustafa@chu-clermontferrand.fr.
authors.forename: Farès
authors.initials: F
authors.lastname: Moustafa
authors.affiliation: Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Barcelona, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Fernández
authors.affiliation: Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Fernández-Capitán
authors.affiliation: Department of Internal Medicine, Hospital General Virgen de la Luz, Cuenca, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Nieto
authors.affiliation: Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Pedrajas
authors.affiliation: Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Visoná
authors.affiliation: Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Valero
authors.affiliation: Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Deu-Hospital General, Barcelona, Spain.
authors.forename: Pablo Javier
authors.initials: PJ
authors.lastname: Marchena
authors.affiliation: Department of Haematology, Galilee Medical Center, Nahariya, Israel.
authors.forename: Andrei
authors.initials: A
authors.lastname: Braester
authors.affiliation: Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Barcelona, Universidad Católica de Murcia, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000139:chemically induced*; D054556:Venous Thromboembolism / Q000150:complications / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants
keywords: A real-life study; Anticoagulant therapy; Uterine bleeding; Venous thromboembolism