Abnormal vaginal bleeding in women of reproductive age treated with edoxaban or warfarin for venous thromboembolism: a post hoc analysis of the Hokusai-VTE study

BJOG. 2018 Nov;125(12):1581-1589. doi: 10.1111/1471-0528.15388. Epub 2018 Jul 20.

Abstract

Objective: To investigate the characteristics and outcome of abnormal vaginal bleeding in women receiving edoxaban or warfarin for treatment of venous thromboembolism (VTE).

Design and setting: Post hoc analysis of the Hokusai-VTE study, a multicentre, randomised, double-blind trial comparing edoxaban with warfarin for acute symptomatic VTE.

Population: Women below 50 years receiving edoxaban or warfarin for treatment of VTE.

Methods: We collected data on diagnostic measures, treatment, and clinical outcome of abnormal vaginal bleeding events.

Main outcome measures: Occurrence of major and clinically relevant nonmajor (CRNM) abnormal vaginal bleeding events.

Results: In all, 628 women aged under 50 years were treated with edoxaban and 665 with warfarin. The rate of abnormal vaginal bleeding was 15/100 person-years (py) (95% CI 11-19) in women receiving edoxaban and 9/100 py (95% CI 6-12) in the warfarin group (hazard ratio: 1.7, 95% CI 1.1-2.5). Major abnormal vaginal bleeding occurred in eight (1.3%) women on edoxaban and in three (0.9%) women receiving warfarin [odds ratio (OR) 2.8; 95% CI 0.8-10.8], and CRNM abnormal vaginal bleeding occurred in 53 (8.4%) women treated with edoxaban and in 37 (5.6%) on warfarin therapy (OR 1.6, 95% CI 1.0-2.4). Over 85% of all vaginal bleeds were characterised by heavy menstrual bleeding. Major bleeds frequently required treatment, and in more than 75% of patients anticoagulant therapy was adjusted. The severity of clinical presentation and course of major and CRNM bleeds was mild in most patients.

Conclusions: Abnormal vaginal bleeding occurred more frequently in women treated with edoxaban than with warfarin. Reassuringly, most events could be managed conservatively and had a mild outcome.

Tweetable abstract: Abnormal vaginal bleeding occurred more frequently in women treated with edoxaban than with warfarin.

Keywords: Abnormal uterine bleeding; edoxaban; oral anticoagulants; vaginal bleeding; venous thromboembolism; warfarin.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anticoagulants / adverse effects*
  • Double-Blind Method
  • Female
  • Humans
  • Middle Aged
  • Pyridines / adverse effects*
  • Thiazoles / adverse effects*
  • Treatment Outcome
  • Uterine Hemorrhage / chemically induced*
  • Venous Thromboembolism / drug therapy*
  • Warfarin / adverse effects*

Substances

  • Anticoagulants
  • Pyridines
  • Thiazoles
  • Warfarin
  • edoxaban

Grant support