Abstract
Study Objective
The prevalence, clinical features, and management of gynecologic bleeding complications
and health care provider awareness of these in postmenarchal adolescents receiving
antithrombotic medications has rarely been addressed in the literature. We sought
to address these issues in a review of our experience in a pediatric tertiary care
center.
Design, Setting, and Participants
A retrospective chart review was conducted with institutional review board approval
from 2004 to 2014, on eligible postmenarchal adolescents receiving antithrombotic
medications. Descriptive statistics were used.
Results
Sixty-eight adolescents received antithrombotic medications (thromboembolism in 67
of 68; 99%; cardiac causes in 4 of 68; 6%), which included enoxaparin, warfarin, unfractionated
heparin, alteplase, fondaparinux, and aspirin. Heavy menstrual bleeding (HMB) screening
questions were documented by treating hematologists in 52 of 68 patients (76%; 95%
confidence interval, 65%-86%). Adolescent gynecology consult was requested for 25
of 68 patients (37%). After antithrombotic medications were started, 13 of 68 (19%)
developed HMB. Anemia was found in 43% of patients tested (18 of 42); 50% (9 of 18)
and 78% patients (14 of 18) received packed red blood cell transfusion and iron therapy,
respectively. Five patients (5 of 68; 7%) developed hemorrhagic ovarian cysts, 40%
(2 of 5) were treated with surgery, 16% (1 of 5) received transfusions, and 100% (5
of 5) received or continued progesterone-only therapy with no recurrence.
Conclusion
Adolescents receiving antithrombotic medications are at risk of developing gynecologic
bleeding complications, which can result in anemia, hospitalization, transfusions,
or surgery. Provider awareness/screening of HMB as a bleeding complication of antithrombotic
medications is less than optimal. Future prospective studies in adolescents receiving
antithrombotic medications are needed to better evaluate provider awareness and the
prevalence of gynecologic bleeding complications, which can lead to effective management.
Key Words
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Article info
Publication history
Published online: December 20, 2017
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc.
