OC 62.2 - National UK Survey on Variation of Clinical Practice in Management of Heavy Menstrual Bleeding in Anticoagulated Patients: It Is Time for Clinical Trials

Tuesday, June 25, 2024

15:00 – 15:15 ICT

Room: Ballroom B2

Presenting Author(s)

Eman Hassan, MSc

Haematology speciality registrar
University Hospitals of Birmingham
Birmingham, England, United Kingdom

Co-Author(s)

RB

Richard Buka

PhD student
Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham , United Kingdom
Birmingham, England, United Kingdom
PN

Philip Nicolson

Associate professor
Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham , United Kingdom
Birmingham, England, United Kingdom
NJ

Nkemdirim Ernest Jacob

Haematology speciality registrar
Royal Hospital For Children, Glasgow
Glasgow, Scotland, United Kingdom
YA

Yasir Alhamdi

Haematology speciality registrar
Sheffield Teaching Hospitals NHS foundation Trust
Sheffield, England, United Kingdom
LR

Lucy Rose

Haematology speciality registrar
Sheffield Teaching Hospitals NHS Foundation Trust
Sheffield, England, United Kingdom
TN

Taran Nandra

Haematology speciality registrar
King's College NHS foundation trust
Kent Surrey Sussex, England, United Kingdom
HC

HaemSTAR Collaborators

Haematology speciality registrars
Haematology Trainee Network
Birmingham, England, United Kingdom
DS

David Sutton

Haematology consultant
University Hospitals North Midlands
West Midlands, England, United Kingdom

Background: Heavy menstrual bleeding (HMB) is a challenging complication in patients on anticoagulation, negatively impacting their health and quality of life.

Aims: In order to understand current practice in managing HMB on anticoagulation for acute venous thromboembolism (VTE).

Methods: We conducted a national survey that was distributed to UK consultants running haemostasis and thrombosis (H&T) clinics and/or providing haemostasis advice.

Results: Respondents included 98 haematology consultants, including 10 paediatric haematology specialists, and 3 consultant clinical pharmacists.74.5% run H&T clinics, while 25.5% only provide liaison advice. Apixaban was the favoured choice, followed by LMWH and dabigatran. 95% of respondents reported they rarely or never pause anticoagulation due to HMB for patients with recent VTE. There was variation in the use of tranexamic acid (TXA) for HMB post-VTE with 35.3% administering it at any time, 20.6% waiting four weeks post-VTE, and 11.8% waiting 3 months, while 7.8% do not use TXA at all. Regarding the choice of oral contraceptive pills, 47.1% recommend stopping oestrogen containing pills, and 64.7% would not recommend it for controlling HMB despite ongoing anticoagulation.
In addition to exploring clinical practice variations, the survey aimed to assess clinicians' willingness to participate in a clinical for TXA use in HMB patients on anticoagulation for acute VTE. The majority of respondents agreed that the existing evidence does not sufficiently demonstrate an increased risk of VTE with TXA use in patients with recent VTE, on anticoagulation. Despite this consensus: only 34.3% of respondents were strongly willing to enrol patients. 30.4% reported having some concerns about the RCT due to the context of acute VTE and 5.9% believed the risks of TXA in this setting outweighed the benefits.

Conclusion(s): The Variation in HMB management in anticoagulated patients and the ongoing uncertainty around TXA use indicate the need for a RCT to establish evidence-based standardisation.