Concomitant use of combined hormonal contraceptives and antifibrinolytic agents for the management of heavy menstrual bleeding: A practice pattern survey. Issue 204 (August 2021)

• Record Type: Journal Article
• Authors: Lim, Ming Y.; Olson, Lenora; Rajpurkar, Madhvi A.; Weyand, Angela C.
• Is Part Of: Thrombosis research. Issue 204(2021)
• Page Start: 95
• Page End: 100
• Publication Date: 2021-08
• Subjects: CHCs combined hormonal contraceptives -- HMB heavy menstrual bleeding -- TXA tranexamic acid -- VTE venous thromboembolism; Antifibrinolytics -- Heavy menstrual bleeding -- Thrombosis -- Hormonal contraceptives; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2021.06.006
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Concomitant antifibrinolytic agents and combined hormonal contraceptives (CHC) have been anecdotally used to manage refractory heavy menstrual bleeding (HMB). Yet, there remains uncertainty among clinicians regarding the safety of this therapeutic option as concomitant CHC is listed as a contraindication to tranexamic acid use in the United States. Aim: To describe current treatment practices and physician-reported safety and effectiveness of concomitant antifibrinolytics and CHCs. Methods: We surveyed clinician members of the Hemostasis and Thrombosis Research Society and the Foundation of Women and Girls with Blood Disorders using a web-based survey. We also shared the survey link on Twitter. Results: Of the 224 respondents who completed the survey, 214 treated women of reproductive age with HMB. Of the 214 respondents, 138 (64%) had treated at least 1 woman with concomitant antifibrinolytic agents and CHCs in the past 12 months. Over half of these respondents ( n = 77, 57%) reported that at least 50% of women had resolution of refractory HMB. One respondent reported an arterial or venous thrombotic event that occurred in 1 woman. Conclusion: We found that the use of concomitant CHCs and antifibrinolytic agent for refractory HMB is prevalent, appears to be efficacious and is relatively safe. Further research is warranted. Highlights: Antifibrinolytics are contraindicated in women on hormonal contraceptives. Concomitant use of these agents is anecdotally used for heavy menstrual bleeding. Concomitant use of these agents is prevalent, efficacious and relatively safe. Subspecialty clinicians are more likely to prescribe concomitant use.