Key result
In women of reproductive age, FXa inhibitors increase heavy menstrual bleeding, while inadvertent DOAC exposure during early pregnancy carries a 2% to 4% risk of major birth defects.
Why the study?
DOACs are increasingly used in younger patients, but their profile may have drawbacks for younger female patients in whom reproductive issues need special considerations.
What are the risks of heavy menstrual bleeding and embryotoxicity associated with DOAC use in women of reproductive age?
What are the risks of heavy menstrual bleeding and embryotoxicity associated with DOAC use in women of reproductive age?
This review provides crucial clinical guidance on managing heavy menstrual bleeding and structuring pregnancy planning for women taking direct oral anticoagulants.
Counsel reproductive-age women on HMB risk and contraception before FXa inhibitors; leaves open need for prospective registries to refine embryotoxicity estimates.
Direct oral anticoagulants (DOACs) are replacing warfarin and other vitamin K antagonists for a wide range of indications. Advantages of DOAC therapy are fewer food and drug interactions and fixed dosing without routine laboratory monitoring, making DOACs the perfect choice especially for younger patients, in whom the main indication for anticoagulation is prevention and treatment of venous thromboembolism (VTE). Although DOACs are safer and much more convenient than other anticoagulant alternatives, their profile may have drawbacks, especially for younger female patients in whom reproductive issues need special considerations. These may include the issue of heavy menstrual bleeding (HMB) during anticoagulant therapy, the embryotoxicity risk from inadvertent DOAC exposure during pregnancy, and the prevention or planning of pregnancies during DOAC therapy. This review summarizes the most relevant evidence in this increasingly important field of women's health.
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Beyer‐Westendorf et al. (2021) conducted a review in Venous thromboembolism. Direct oral anticoagulants (DOACs) vs. Vitamin K antagonists or LMWH was evaluated. In women of reproductive age, FXa inhibitors increase heavy menstrual bleeding, while inadvertent DOAC exposure during early pregnancy carries a 2% to 4% risk of major birth defects.
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