Key result
Tailored cyclic warfarin achieves complete DVT recanalization over 15 months without recurrent thrombosis or major bleeding.
Why the study?
Managing anticoagulation in patients with extensive DVT and severe menorrhagia poses significant challenges due to bleeding risk during menstruation.
Does a tailored cyclic warfarin reduction strategy balance thrombotic control and bleeding risk in a patient with DVT and severe menorrhagia?
Case Report (n=1)
Does a tailored cyclic warfarin reduction strategy balance thrombotic control and bleeding risk in a patient with DVT and severe menorrhagia?
A tailored approach of cyclic warfarin reduction during menstruation may safely manage thrombotic control while minimizing severe bleeding in patients with DVT and severe menorrhagia.
May inform individualized anticoagulation in women with DVT and menorrhagia; hypothesis-generating and requires prospective validation.
We present a case of extensive deep vein thrombosis (DVT) in a young woman with concurrent severe menorrhagia and chronic anemia, posing significant challenges for standard anticoagulation. A tailored warfarin-only strategy was employed, in which warfarin dosage was reduced cyclically to achieve subtherapeutic international normalized ratio (INR) levels during menstruation. This approach minimized bleeding without compromising thrombotic control. Over 15 months, complete thrombus recanalization was achieved, with no recurrence of thrombosis or need for hospital admission. Transfusions were administered in a daycare setting. This case illustrates the value of individualized anticoagulation adjustment in patients with high bleeding risk due to cyclic uterine bleeding.
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SM Pai (2026) conducted a case report in Extensive deep vein thrombosis (DVT) with concurrent severe menorrhagia and chronic anemia (n=1). Tailored warfarin-only strategy (cyclically reduced dosage during menstruation) was evaluated on Thrombus recanalization, bleeding, and recurrence of thrombosis. A tailored cyclic warfarin strategy achieving subtherapeutic INR during menstruation allowed complete DVT recanalization over 15 months without thrombosis recurrence or severe bleeding complications.
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