Abnormal Uterine Bleeding Among Oral Anticoagulant Users.

Area of Science:

• Pharmacology
• Gynecology
• Hematology

Background:

• Oral anticoagulants are crucial for preventing thromboembolic events.
• Abnormal uterine bleeding (AUB) is a common gynecological issue.
• The real-world incidence of AUB associated with different oral anticoagulants is not well-established.

Purpose of the Study:

• To estimate the real-world incidence of abnormal uterine bleeding (AUB) following the initiation of oral anticoagulant therapy.
• To stratify AUB incidence by specific anticoagulant agent and patient age group.

Main Methods:

• A nested matched case-control study was conducted using the MarketScan Research Databases (2008-2022).
• Women initiating oral anticoagulants (warfarin, apixaban, rivaroxaban, dabigatran, edoxaban) were matched 1:5 to non-users.
• Abnormal uterine bleeding (AUB) within one year was the primary outcome, analyzed using conditional logistic regression.

Main Results:

• Oral anticoagulant users had a significantly higher incidence of AUB (6.1% vs 3.0%) compared to non-users.
• Anticoagulant users experienced increased odds of AUB-related hospitalizations, emergency department visits, and outpatient encounters.
• Younger women (<50 years) showed a greater relative increase in AUB incidence compared to older women (≥50 years).
• Rivaroxaban was associated with the highest risk of AUB among all evaluated agents.

Conclusions:

• Oral anticoagulant therapy is linked to a significantly elevated risk of abnormal uterine bleeding (AUB).
• The risk of AUB is particularly pronounced in younger women initiating oral anticoagulants.
• Rivaroxaban use confers the highest risk of AUB compared to other oral anticoagulants.