{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T14:05:38Z","timestamp":1777903538469,"version":"3.51.4"},"reference-count":32,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hamostaseologie"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>In premenopausal women treatment with direct oral anticoagulants (DOACs) can be associated with an increased risk of heavy menstrual bleeding (HMB) compared with vitamin K antagonists. These findings come from retrospective or prospective single-center studies and post hoc analysis of regulatory studies in which HMB was not a predefined safety outcome. In most of these publications, there is a lack of information about the use of different contraceptive methods which can influence HMB. Another limitation is the various definitions of HMB, which makes comparison between studies regarding the incidences of HMB difficult.<\/jats:p><jats:p>Therefore, prospective studies are urgently needed to investigate the severity and duration of unaffected menstrual bleeding under oral anticoagulation independently of oral contraceptives or intrauterine devices. An ongoing multicenter German registry is aiming to compare the incidence of unaffected HMB in consecutive women of reproductive age (18\u201350 years) treated with different DOACs because of venous thromboembolism.<\/jats:p><jats:p>When HMB occurs during oral anticoagulation, management includes interruption or dose reduction of anticoagulation with the danger of recurrent venous thrombosis, switch to another oral anticoagulant, or additional use of the antifibrinolytic agent tranexamic acid with the potential risk of thrombosis. Concomitant use of either oral hormonal contraceptive therapy or hormone-releasing intrauterine systems can also reduce HMB.<\/jats:p>","DOI":"10.1055\/a-1891-8187","type":"journal-article","created":{"date-parts":[[2022,11,2]],"date-time":"2022-11-02T23:30:12Z","timestamp":1667431812000},"page":"337-347","source":"Crossref","is-referenced-by-count":14,"title":["Bleeding Issues in Women Under Oral Anticoagulation"],"prefix":"10.1055","volume":"42","author":[{"given":"Lida","family":"Kalmanti","sequence":"additional","affiliation":[{"name":"Center of Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edelgard","family":"Lindhoff-Last","sequence":"additional","affiliation":[{"name":"Cardioangiology Center Bethanienhospital, Coagulation Center and Coagulation Research Center, Frankfurt, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,11,2]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1159\/000320336","article-title":"Pictorial blood loss assessment chart in the evaluation of heavy menstrual bleeding: diagnostic accuracy compared to alkaline hematin","volume":"71","author":"M S Zakherah","year":"2011","journal-title":"Gynecol Obstet Invest"},{"issue":"01","key":"ref2","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1182\/hematology.2020000166","article-title":"Abnormal uterine bleeding in users of rivaroxaban and apixaban","volume":"2020","author":"A E Jacobson-Kelly","year":"2020","journal-title":"Hematology (Am Soc Hematol Educ Program)"},{"issue":"08","key":"ref3","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1111\/j.1471-0528.1990.tb16249.x","article-title":"Assessment of menstrual blood loss using a pictorial 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