Rate of Abnormal Uterine Bleeding in Women on Anticoagulation for Venous Thromboembolism: Systematic Review and Meta-analysis - PubMed

4 days ago

Venous thromboembolism (VTE) disproportionately affects reproductive-age women.
Abnormal uterine bleeding (AUB) associated with anticoagulation, particularly direct oral anticoagulants (DOACs), is under-reported.
Suboptimal AUB management may lead to iron deficiency anemia (IDA) and recurrent VTE.
Systematic review and meta-analysis compared AUB incidence in women on DOACs vs. LMWH/VKA for VTE.
Primary outcomes included major bleeding (MB), clinically relevant non-major bleeding (CRNMB), and unspecified AUB.
Secondary outcomes were IDA and recurrent VTE.
21 studies were included (10 RCTs, 11 cohorts) with varied AUB definitions.
Overall uterine bleeding risk did not differ between DOACs and LMWH/VKA.
DOACs showed no increased MB/CRNMB risk but had higher unspecified AUB.
Rivaroxaban showed a 2.7-fold higher AUB risk vs. LMWH/VKA.
Data on iron deficiency and anemia were limited.
Improved reporting and consistent definitions are needed to understand gender disparities in VTE treatment.

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