Is Uterine Artery Embolization a Viable Treatment Option for Anticoagulation Related Abnormal Uterine Bleeding?
BACKGROUND AND PURPOSE:
Iatrogenic abnormal uterine bleeding (AUB-I) may occur with administration of anticoagulation therapy
Wattamwar et al. (Journal of Minimally Invasive Gynecology, 2021) quantified the effectiveness of uterine artery embolization (UAE) for managing anticoagulant-associated AUB (AA-AUB)
Retrospective case series
patients were identified using an imaging database search
AUB-I provoked or aggravated by initiation of anticoagulation therapy
New onset or worsening bleeding
Acute cases were identified using the FIGO criteria
Short and long-term outcomes were obtained
Mean age 44.9 (range 35 to 54)
Most common indication for anticoagulation: venous thromboembolic disease, 92%
Patients with anticipated life-long anticoagulation needs: 58%
Follow-up: Outcomes ranged from 10 months to 10 years post-procedure
Transfusion required: 70%
No specific anticoagulant was more common in this cohort
UAE procedures within 10 days of anticoagulation initiation: 54%
Attempted and failed medical management, myomectomy, or endometrial ablation prior to UAE: 71%
Improvement with UAE
Substantial improvement or resolution of AUB, with continued anticoagulation: 88%
No improvement and treated with hysterectomy: 14%
Amenorrhea immediately following UAE occurred in 1 patient at age 45
UAE was effective at improving or resolving acute AUB-I related to anticoagulation in 88% of patients
The authors state
UAE can be effective with or without continued medical management in treating AA-AUB, allowing continuation of anticoagulation therapy, with high rates of preserved menses and low rates of hysterectomy
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