{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T23:18:20Z","timestamp":1787872700401,"version":"build-2784847793"},"reference-count":20,"publisher":"Georg Thieme Verlag KG","issue":"09","license":[{"start":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T00:00:00Z","timestamp":1762905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"International ERISTA-Grant by the Bristol Myers Squibb, Pfizer Alliance","award":["REQ-0000021564"],"award-info":[{"award-number":["REQ-0000021564"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Heavy menstrual bleeding (HMB) is a common complication of anticoagulant therapy in menstruating women with venous thromboembolism (VTE). Direct oral anticoagulants (DOAC) used for VTE treatment may differ in their menstrual bleeding profiles. Therefore, the prospective multicenter noninterventional investigator-initiated HEMBLED registry (heavy menstrual bleeding in patients treated with DOAC) was performed to analyze spontaneous menstrual bleeding in women treated with therapeutic DOAC doses.<\/jats:p>\n                  <jats:p>A modified pictorial blood assessment chart (PBAC) score was used to define the severity of menstrual bleeding. Patients were only included when they did not use hormonal or intrauterine contraception methods. The prospective follow-up was 4 months. The primary endpoint was the comparison of the PBAC scores between the individual DOAC groups.<\/jats:p>\n                  <jats:p>Overall, 73 patients with 213 monthly assessments of the PBAC scores were analyzed. Patients were on average 35 years old and were anticoagulated with apixaban (62%), rivaroxaban (26%), edoxaban (7%), or dabigatran (6%). The PBAC scores of the rivaroxaban group (mean: 145 points) were significantly increased by 54% compared with the apixaban group (mean: 93 points, p\u2009=\u20090.0193). HMB (PBAC score\u2009&gt;\u2009100 points) at least once was detected in 53% of the apixaban group compared with 79% of the rivaroxaban group (p\u2009=\u20090.0913). The duration of menstrual bleeding was numerically shorter in the apixaban group compared with the rivaroxaban group (p\u2009=\u20090.1894).<\/jats:p>\n                  <jats:p>DOAC differ in their influence on the intensity of spontaneous menstrual bleeding. This should be taken into account when advising young women with VTE who need an oral anticoagulant.<\/jats:p>","DOI":"10.1055\/a-2724-4458","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:27:16Z","timestamp":1762993636000},"page":"974-982","source":"Crossref","is-referenced-by-count":2,"title":["Heavy Menstrual Bleeding in Women Treated with Direct Oral Anticoagulants: Results of the Prospective HEMBLED Registry"],"prefix":"10.1055","volume":"126","clinical-trial-number":[{"clinical-trial-number":"nct04477837","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Edelgard","family":"Lindhoff-Last","sequence":"additional","affiliation":[{"name":"Cardioangiology Center Bethanienhospital (CCB), Department of Coagulation Disorders, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inka","family":"Wiegratz","sequence":"additional","affiliation":[{"name":"Fertility Center Am Palmgarten, Department of Obstetrics and Gynecology, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Ott","sequence":"additional","affiliation":[{"name":"Cardioangiology Center Bethanienhospital (CCB), Department of Coagulation Disorders, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Weil","sequence":"additional","affiliation":[{"name":"Praxisklinik in Mittelhessen, Department of Angiology, Wetzlar, Hessen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Sucker","sequence":"additional","affiliation":[{"name":"Coagumed Gerinnungszentrum, Department of Haemostaseology, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Halimeh","sequence":"additional","affiliation":[{"name":"Coagulation Center Rhein-Ruhr, Department of Haemostaseology, Duisburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5337-3797","authenticated-orcid":false,"given":"Holger","family":"Seidel","sequence":"additional","affiliation":[{"name":"Center for Blood Coagulation Disorders and Transfusion (CBT), Department of Haemostaseology, Bonn and Dortmund, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Schambeck","sequence":"additional","affiliation":[{"name":"Haemostasikum, Department of Haemostaseology, M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin","family":"Kirchmayr","sequence":"additional","affiliation":[{"name":"Punktmed Medical Care Center, Department of Angiology and Haemostaseology, Amberg and N\u00fcrnberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,11,12]]},"reference":[{"issue":"16","key":"ref1","doi-asserted-by":"crossref","first-page":"1764","DOI":"10.1182\/blood.2022017101","article-title":"Incidence and impact of anticoagulation-associated abnormal menstrual bleeding in women after venous thromboembolism","volume":"140","author":"C MM de Jong","year":"2022","journal-title":"Blood"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1055\/a-1891-8187","article-title":"Bleeding issues in women under oral anticoagulation","volume":"42","author":"L Kalmanti","year":"2022","journal-title":"Hamostaseologie"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"100072","DOI":"10.1016\/j.rpth.2023.100072","article-title":"How do anticoagulants impact menstrual bleeding and quality of life? - the PERIOD 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