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Because women are predisposed to thrombotic events during pregnancy and while receiving oral contraceptives or hormone replacement therapy, some may need to take anticoagulants. Using the risk/benefit analysis method, the authors examine an individualized approach to both hemorrhagic and nonhemorrhagic complications associated with anticoagulation-targeted interventions.
The benefits of anticoagulation therapy often outweigh the risks; however, the complications that can occur in women taking anticoagulants are considerable, ranging from menorrhagia to teratogenesis. Therefore, clinicians should carefully evaluate each patient's risk profile and consider the potential physical and psychosocial effects of these adverse events prior to initiating therapy.
COMPLICATIONS OF ANTICOAGULATION
Hemorrhagic Complications
The bleeding complications of anticoagulant therapy specific to women are limited to menorrhagia. Scientifically, menorrhagia is defined as blood loss of >80 mL per menstrual cycle. It has been shown that 50% of women receiving oral anticoagulant therapy (warfarin) will experience menorrhagia, with a mean blood loss of 98 mL per menstrual cycle. The range of menstrual blood loss during oral anticoagulant therapy varies greatly from patient to patient (range, 9-239 mL).1 Two-thirds of women with menorrhagia will suffer from iron deficiency and require iron replacement therapy.
Menorrhagia is not just a medical problem; it is a psychosocial issue that must be considered when deciding if intervention is needed. Medically defined menorrhagia (>80 mL/cycle) may not be particularly bothersome to one patient, whereas another patient who does not even meet these criteria may perceive her menstrual periods to be excessive and unmanageable; thus, the individual woman's perception of heavy menstrual periods needs to be addressed. If she is anemic, this should be managed with up to four doses per day of a well-tolerated, 65-mg iron supplement. Stopping the anticoagulant therapy may be tempting, but this would require careful evaluation of the risk of thrombotic events versus the perceived...