Study Finds Women Who Take Anticoagulants Can Use Hormonal Therapy

Ida Martinelli MD, PhD A Bianchi Bonomi Hemophilia and Thrombosis Center Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy

Dr. Martinelli Interview with:
Ida Martinelli MD, PhD
A Bianchi Bonomi Hemophilia and Thrombosis Center
Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
Milan, Italy 

Medical Research: What is the background for this study? What are the main findings?

Dr. Martinelli: Hormonal therapies are associated with an increased risk of venous thromboembolism. Patients with acute deep-vein thrombosis or pulmonary embolism require anticoagulation, but women of childbearing potential require also an adequate contraception, as oral anticoagulants cross the placenta potentially leading to embryopathy or fetal bleeding. This study was aimed to evaluate the safety of hormonal therapies together with anticoagulant therapies in terms of recurrent venous thrombosis and uterine bleeding. We demonstrated for the first time that women who take oral anticoagulants can safely use hormonal therapies, as their risk of recurrent venous thromboembolism or uterine bleeding is not increased.

Medical Research: What should clinicians and patients take away from your report?

Dr. Martinelli: Clinicians can leave or start hormonal therapies, either for contraception or post-menopause and either estrogen-containing or progestin-only preparations, to their patients who are anticoagulated with vitamin-K antagonists or the direct anti-factor X rivaroxaban. Their risk of recurrent venous thrombosis is not increased in comparison with women who do not take hormonal therapies.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Martinelli: A higher rate of uterine bleeding was observed with rivaroxaban than with vitamin-K antagonisis, in particular in women with anemia or uterine fibroids at baseline. This finding needs confirmation and further mechanistic exploration.


Recurrent venous thromboembolism and abnormal uterine bleeding with anticoagulant and hormone therapy use

Ida Martinelli, Anthonie W.A. Lensing, Saskia Middeldorp, MarcelLevi, Jan Beyer-Westendorf, Bonno van Bellen, HenriBounameaux, Timothy A. Brighton, Alexander T. Cohen, MilaTrajanovic, Martin Gebel, Phuong Lam, Philip S. Wells, Martin H.Prins

Blood Jan 2015, DOI: 10.1182/blood-2015-08-665927

Ida Martinelli MD, PhD (2016). Study Finds Women Who Take Anticoagulants Can Use Hormonal Therapy 

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