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Introduction: The aim of this study was: 1 To study the pattern of menstrual abnormality and severity in women on anticoagulant and antiplatelet drugs. 2 To analyze the correlation of prothrombin time PT, International Normalised ratio INR and the bleeding severity. 3 To discuss the various management options in unexpected emergencies and menstrual complications in this subset of women on anticoagulants. Material & Methods: It is a prospective study, over a period of 18 months from July 2011 to december 2012. We had 44 women on antithrombotic therapy. 32 women were on anticoagulants and 12 were on antiplatelet agents. The severity of bleeding pattern was assessed with pictoral bleeding assessment chart PBAC. 1 Out of 44 women studied, 32 women were on anticoagulants and 12 were on antiplatelet agents. 26 81.25% were on acenocoumarol, 5 15.62% on warfarin, 1 3.12% on heparin, among the 12 antiplatelet users, 8 66.66% were on aspirin and 4 33.33% on clopidogrel. 2 The indication for anticoagulants was mitral valve replacement MVR in 9, double valve replacement DVR in 6, aortic valve replacement AVR in 3, severe pulmonary artery hypertension PAH in 2, severe mitral stenosis MS with atrial thrombus in 2, deep vein thrombosis DVT in 5, severe mitral regurgitation MR in one, the other indications were subdural hematoma, thromboendarterectomy, chronic kidney disease CKD stage V, coarction of aorta, one each. The indication for antiplatelet therapy was percutaneous transluminal coronary angioplasty PTCA in 3, Wolf Parkinson White WPW syndrome + atrial fibrillation AF, acute myocardial infarction AMI, coronary artery bypass graft CABG, mid basilar artery aneurysm, renal allograft recipient, dialated cardiomyopathy, aortic aneurysm repair, hypertension and unstable angina one each. Results: In women on anticoagulants 32, the main complaint was menorrhagia-heavy menstrual bleeding HMB in 20, polymenorrhoea with menorrhagia in 4, continuous per vaginal PV bleeding in 6. One lady had postmenopausal bleeding. Among the 12 antiplatelet users the main complaint was menorrhagia in 8, polymenorrhoea with menorrhagia in 2, postmenopausal bleeding in one. While on antithrombotic therapy apart from heavy menstrual bleeding, two women had intraperitoneal bleeding, two had post menopausal bleeding, two had secondary postpartum bleeding PPH. CVA due to embolic stroke occurred in three, one during the study period. Subchoroidal haemorrhage causing choroidal detachment was noted in one. Conclusions: In patients with prolonged INR, excessive uterine bleeding can be an alerting initial manifestation. Antithrombotic therapy can cause HMB or exaggerate the symptom of HMB due to an underlying gynaec pathology. Mefanamic acid and norethisterone were used to arrest heavy menstrual bleeding. Antithrombotic therapy in women needs special consideration with alterations in menstrual pattern and contraception. Pregnancy and postpartum period present special challenges.

KEYWORDS

Anti thrombotic Therapy in Women, Anticoagulants, HMB, PMB, PPH

Cite this paper

Devabhaktuni, P. , Thomas, P. , Kapadia, A. ,  , S. and Bhupatiraju, S. 2017 Menstrual Abnormalities and Gynaecological Problems in Women on Anticoagulant and Antiplatelet Therapy: Management Options. Open Journal of Obstetrics and Gynecology, 7, 581-599. doi: 10.4236-ojog.2017.75061.





Author: Pratibha Devabhaktuni1, Precella Thomas1, Anuj Kapadia2, Sridevi 2, Somaraju Bhupatiraju2

Source: http://www.scirp.org/



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