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A prognostic score to identify women at increased risk for abnormal uterine bleeding during anticoagulation for venous thromboembolism

2023; Elsevier BV; Volume: 13; Linguagem: Inglês

10.1016/j.tru.2023.100148

2666-5727

G. Sarlon-Bartoli, Juan Criado, Saskia Middeldorp, José Antonio Nieto, Carmen Díaz‐Pedroche, Farès Moustafa, N. Ruiz‐Giménez, Benjamin Brenner, Manuel Monréal, Pierpaolo Di Micco, Manuel Monréal, Paolo Prandoni, Benjamin Brenner, Dominique Farge, Raquel Barba, Pierpaolo Di Micco, Laurent Bertoletti, Sebastian Schellong, Inna Tzoran, Abílio Reis, Marijan Bosevski, H Bounameaux, Radován Malý, Peter Verhamme, Joseph A. Caprini, My Bui, M.D. Adarraga, Pilar Agudo, Cristina Amado, J.I. Arcelus, Aitor Ballaz, J. Bascuñana, Raquel Barba, C. Barbagelata, M. Barrón, B. Barrón‐Andrés, Á. Blanco-Molina, Fahd Beddar Chaib, Enrique Ramón Botella, I. Cañas, R. Carrero-Arribas, I. Casado, Paula Cerdà, Leyre Chasco, Juan Criado, Cristina de Ancos, Javier de Miguel‐Díez, J. del Toro, Pablo Demelo‐Rodríguez, A.M. Díaz-Brasero, Carmen Díaz‐Pedroche, J.A. Díaz‐Peromingo, I.M. Domínguez, Álvaro Dubois-Silva, J.C. Escribano, F. Espósito, Ana Isabel Farfán‐Sedano, C. Falgá, Carmen Fernández‐Capitán, B. Fernández-Jiménez, J. Fernández-Muixí, José Luis Fernández‐Reyes, Carme Font, Iria Francisco, Francisco Galeano‐Valle, M.A. García, F García‐Bragado, Marta García de Herreros, Olga Gavín-Blanco, A. Gil-Díaz, Covadonga Gómez‐Cuervo, Antón Gómez-Mosquera, M. Gonzalez-Moreno, E Grau, L. Guirado, Juan Mata, Luis Blasco, Luis Jara‐Palomares, M.J. Jaras, David León Jiménez, I. Jou, M.D. Joya, B. Lacruz, S. Lainez-Justo, A. Latorre, Jorge Roberto Perrout de Lima, Lobo Jl, M. López-De la Fuente, Luciano López‐Jiménez, Manuel López‐Meseguer, Patricia López-Miguel, Juan J. López-Núñez, Raquel López-Reyes, J.B. López‐Sáez, M.A. Lorente, A. García de Lorenzo, Olga Madridano, Ana M. Maestre, P.J. Marchena, Javier Miguel Martín Guerra, F. Martín‐Martos, M Mellado, Edward Mena, Jorge Moisés, M.I. Mercado, Manuel Monréal, A. Muñoz-Blanco, Gema Muñoz, M.V. Morales, José Antonio Nieto, E. Noguera-Gras, M.J. Núñez-Fernández, M. Olid-Velilla, Jeisson Osorio, S. Otálora, Remedios Otero, D. Paredes, Pedro Parra, Virginia Parra, José María Pedrajas, Maria Isabel Perez-Lopez, M.L. Peris, M.L. Pesce, José Antonio Porras, J. Poyo-Molina, Ramón Puchades, Antoni Riera‐Mestre, F. Rivera-Cívico, Alberto Rivera-Gallego, María Roca, V. Rosa, A. Rodríguez-Cobo, Consolación Rodríguez-Matute, Pedro Ruiz‐Artacho, N. Ruiz‐Giménez, Justo Ruiz-Ruiz, G. Salgueiro, Teresa Sancho, Vanesa Sendín, Patricia Sigüenza, S. Soler, Beatriz Suárez-Rodríguez, J.M. Suriñach, G. Tiberio, Marı́a Isabel Torres, Andrea Torres-Sánchez, J. Trujillo-Santos, Fernando Uresandi, Esther Usandizaga, R. Valle, J.F. Varona, Lydia Vela, J. Vela, A. Villalobos, Paula Villares, Cihan Ay, Stephan Nopp, Ingrid Pabinger, Marscha M. Engelen, C. Martens, Peter Verhamme, Hugo Hyung Bok Yoo, J.D. Arguello, Ana Cristina de Albuquerque Montenegro, Juan Roa, Jana Hirmerová, Radován Malý, Sandrine Accassat, Laurent Bertoletti, A. Bura-Rivière, Judith Catella, Romain Chopard, Françis Couturaud, O. Espitia, Sarah El Harake, Raphaël Le Mao, I. Mahé, Farès Moustafa, L. Plaisance, G. Sarlon-Bartoli, Pierre Suchon, E. Versini, Sebastian Schellong, Andrei Braester, Benjamin Brenner, Gili Kenet, Inna Tzoran, Parham Sadeghipour, Manuela Basaglia, Franca Bilora, Cristiano Bortoluzzi, B. Brandolin, Maurizio Ciammaichella, Antonina De Angelis, Francesco Dentali, Pierpaolo Di Micco, Egidio Imbalzano, Simona Merla, Raffaele Pesavento, Paolo Prandoni, Carmine Siniscalchi, Antonella Tufano, Adriana Visonà, Ngoc Vo Hong, Beniamino Zalunardo, Dana Kigitoviča, Elina Rusa, Andris Skride, S. Fonseca, Manuel Maréchal, J. Meireles, Marijan Bosevski, A. Eftimova, Marija Zdraveska, H Bounameaux, Lucia Mazzolai, Avinash Aujayeb, Joseph A. Caprini, Ido Weinberg, My Bui,

Blood Coagulation and Thrombosis Mechanisms

Little is known about the clinical characteristics of women at increased risk for abnormal uterine bleeding (UB) during anticoagulation for venous thromboembolism (VTE). We used the RIETE registry to identify the baseline characteristics of women developing abnormal UB during anticoagulation. We used logistic regression analysis to identify independent predictors for abnormal UB. Then, we built a prognostic score to identify at-risk women. From March 2001 through October 2022, there were 54,372 women with VTE. During anticoagulation (median, 181 days), 318 (0.6%) developed abnormal UB (major bleeding 88, clinically relevant non-major (CRNM) 230). On multivariable analysis, women aged 70 kg, with uterine cancer, recent UB, anemia, estrogen-related VTE, or receiving rivaroxaban or apixaban were at increased risk for abnormal UB. Using the prognostic score, 42,273 women (78%) were at low-risk, 8,828 (16%) intermediate-, and 3,271 (6.1%) at high-risk for abnormal UB. Their rates of abnormal UB were: 0.28 (95%CI: 0.23–0.35), 1.32 (95%CI: 1.07–1.61) and 7.12 (95%CI: 5.98–8.41) bleeds per 100 patient-years, respectively. The c-statistics was 0.80 (95%CI: 0.77–0.83). The rates of major UB were: 0.06 (95%CI: 0.04–0.09), 0.43 (95%CI: 0.30–0.60) and 1.85 (95%CI: 1.31–2.53) per 100 patient-years, respectively (c-statistics: 0.84; 95%CI: 0.80–0.89). The rates of CRNM uterine bleeding were: 0.21 (95%CI: 0.17–0.26), 0.85 (95%CI: 0.65–1.08), and 5.02 (95%CI: 4.09–6.10) bleeds per 100 patient-years, respectively (c-statistics: 0.78; 95%CI: 0.75–0.82). Using 7 variables easily available at admission, we built a prognostic score that reliably identified women with VTE at increased risk for abnormal UB during anticoagulation.