{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:36:25Z","timestamp":1787164585866,"version":"build-2736575974"},"reference-count":5,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:00:00Z","timestamp":1715558400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T00:00:00Z","timestamp":1715558400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Emerg Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pulmonary embolism is a common and potentially fatal condition. Exogenous estrogens in contraceptives are associated with an increased risk of venous thrombo-embolism. However, discontinuation of a combined oral contraceptive can lead to severe withdrawal bleeding in an anticoagulated patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report a case of a 47-year-old female who presented to the emergency room with a two-day history of worsening shortness of breath and chest pain. Her chronic medication included a combined oral contraceptive pill. Transthoracic echocardiogram showed pulmonary hypertension and right ventricular dilatation. Computerized tomography scan revealed bilateral pulmonary embolism. She received thrombolysis with alteplase and was started on rivaroxaban. Five days after discharge, however, she was readmitted with severe vaginal bleeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusion<\/jats:title>\n                    <jats:p>We describe a case of submassive pulmonary embolism, treated with thrombolysis and anticoagulation, who developed severe vaginal bleeding after stopping the contraceptive pill. This case highlights the importance of detailed menstrual history taking when initiating anticoagulation in women. Discontinuation of oral contraceptives, while important in reducing the risk of recurrent thrombosis, could be postponed until the end of the recommended course of anticoagulation and until a safe alternative form of contraception has been established, if required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12245-024-00639-9","type":"journal-article","created":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T05:02:50Z","timestamp":1715576570000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Double bad luck: pulmonary embolism and vaginal bleeding - a case report"],"prefix":"10.1186","volume":"17","author":[{"given":"Sarah","family":"Shiba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4490-5170","authenticated-orcid":false,"given":"Jan","family":"Van Keer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,5,13]]},"reference":[{"issue":"3","key":"639_CR1","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1161\/ATVBAHA.111.242818","volume":"32","author":"PH Reitsma","year":"2012","unstructured":"Reitsma PH, Versteeg HH, Middeldorp S. Mechanistic view of risk factors for venous thromboembolism. Arterioscler Thromb Vasc Biol. 2012;32(3):563\u20138.","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"639_CR2","unstructured":"https:\/\/reference.medscape.com\/calculator\/86\/pulmonary-embolism-severity-index-pesi"},{"issue":"1","key":"639_CR3","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1182\/hematology.2020000138","volume":"2020","author":"B Samuelson Bannow","year":"2020","unstructured":"Samuelson Bannow B. Management of heavy menstrual bleeding on anticoagulation. Hematology. 2020;2020(1):533\u20137.","journal-title":"Hematology"},{"key":"639_CR4","doi-asserted-by":"crossref","unstructured":"Martinelli I, Lensing AWA, Middeldorp S, Levi M, Beyer-Westendorf J, Van Bellen B et al. Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use. 2016;127(11):1417\u201325. http:\/\/ashpublications.org\/blood\/article-pdf\/127\/11\/1417\/1391833\/1417.pdf","DOI":"10.1182\/blood-2015-08-665927"},{"key":"639_CR5","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.thromres.2017.03.013","volume":"153","author":"FA Klok","year":"2017","unstructured":"Klok FA, Schreiber K, Stach K, Ageno W, Middeldorp S, Eichinger S, et al. Oral contraception and menstrual bleeding during treatment of venous thromboembolism: Expert opinion versus current practice. Thromb Res. 2017;153:101\u20137.","journal-title":"Thromb Res"}],"container-title":["International Journal of Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12245-024-00639-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12245-024-00639-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12245-024-00639-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T05:03:47Z","timestamp":1715576627000},"score":1,"resource":{"primary":{"URL":"https:\/\/intjem.biomedcentral.com\/articles\/10.1186\/s12245-024-00639-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,13]]},"references-count":5,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["639"],"URL":"https:\/\/doi.org\/10.1186\/s12245-024-00639-9","relation":{},"ISSN":["1865-1380"],"issn-type":[{"value":"1865-1380","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,13]]},"assertion":[{"value":"24 September 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 May 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments. Ethical approval was obtained from the Ethical Committee: Ethische Commissie AZ Turnhout, Steenweg op Merksplas 44, 2300 Turnhout, accreditation number OG 192.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"63"}}