Conservative management of corpus luteum haemorrhage in patients on anticoagulation: a report of three cases and review of literature

Gupta, Avantika; Gupta, Sangeeta; Manaktala, Usha; Gupta, Manasvi; Solanki, Vandana

doi:10.1007/s00404-014-3394-2

Cited by 25 publications

(21 citation statements)

References 13 publications

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“…So an unnecessary laparotomy could be avoided by keeping the patient under observation. Gupta A. et al [40] reported conservative management of corpus leuteum haemorrhage in patients on anticoagulants.…”

Section: Intra Peritoneal Bleedingmentioning

confidence: 99%

Menstrual Abnormalities and Gynaecological Problems in Women on Anticoagulant and Antiplatelet Therapy: Management Options

Devabhaktuni¹,

Thomas²,

Kapadia³

et al. 2017

OJOG

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Introduction: The aim of this study was: 1) To study the pattern of menstrual abnormality and severity in women on anticoagulant and antiplatelet drugs. 2) To analyze the correlation of prothrombin time (PT), International Normalised ratio (INR) and the bleeding severity. 3) To discuss the various management options in unexpected emergencies and menstrual complications in this subset of women on anticoagulants. Material & Methods: It is a prospective study, over a period of 18 months from July 2011 to december 2012. We had 44 women on antithrombotic therapy. 32 women were on anticoagulants and 12 were on antiplatelet agents. The severity of bleeding pattern was assessed with pictoral bleeding assessment chart (PBAC). 1) Out of 44 women studied, 32 women were on anticoagulants and 12 were on antiplatelet agents. 26 (81.25%) were on acenocoumarol, 5 (15.62%) on warfarin, 1 (3.12%) on heparin, among the 12 antiplatelet users, 8 (66.66%) were on aspirin and 4 (33.33%) on clopidogrel. 2) The indication for anticoagulants was mitral valve replacement (MVR) in 9, double valve replacement (DVR) in 6, aortic valve replacement (AVR) in 3, severe pulmonary artery hypertension (PAH) in 2, severe mitral stenosis (MS) with atrial thrombus in 2, deep vein thrombosis (DVT) in 5, severe mitral regurgitation (MR) in one, the other indications were subdural hematoma, thromboendarterectomy, chronic kidney disease (CKD) stage V, coarction of aorta, one each. The indication for antiplatelet therapy was percutaneous transluminal coronary angioplasty (PTCA) in 3, Wolf Parkinson White (WPW) syndrome + atrial fibrillation (AF), acute myocardial infarction (AMI), coronary artery bypass graft (CABG), mid basilar artery aneurysm, renal allograft recipient, dialated cardiomyopathy, aortic aneurysm repair, hypertension and unstable angina one each. Results: In women on anticoagulants (32), the main complaint was menorrhagia/heavy menstrual bleeding (HMB) in 20, polymenorrhoea with menorrhagia in 4, How to cite this paper: Devabhaktuni, P., Thomas, P., Kapadia, A., Sridevi and Bhupatiraju, S. 582continuous per vaginal (PV) bleeding in 6. One lady had postmenopausal bleeding. Among the 12 antiplatelet users the main complaint was menorrhagia in 8, polymenorrhoea with menorrhagia in 2, postmenopausal bleeding in one. While on antithrombotic therapy apart from heavy menstrual bleeding, two women had intraperitoneal bleeding, two had post menopausal bleeding, two had secondary postpartum bleeding (PPH). CVA due to embolic stroke occurred in three, one during the study period. Subchoroidal haemorrhage causing choroidal detachment was noted in one. Conclusions: In patients with prolonged INR, excessive uterine bleeding can be an alerting initial manifestation. Antithrombotic therapy can cause HMB or exaggerate the symptom of HMB due to an underlying gynaec pathology. Mefanamic acid and norethisterone were used to arrest heavy menstrual bleeding. Antithrombotic therapy in women needs special consideration with alterations in menstrual patter...

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Section: Intra Peritoneal Bleedingmentioning

confidence: 99%

Menstrual Abnormalities and Gynaecological Problems in Women on Anticoagulant and Antiplatelet Therapy: Management Options

Devabhaktuni¹,

Thomas²,

Kapadia³

et al. 2017

OJOG

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“…The cystic content is mixed with a high attenuation component (45-100 HU) and in some cases it presents a "fluid-fluid haematocrit" level Contrast-enhanced CT may be helpful in excluding other intra-abdominal diseases (e.g., ruptured hepatic adenoma) that can cause hemoperitoneum in the young female patient. [4][5][6][7] A standard protocol is not reported in literature for the management of SH. Historically the treatment of corpus luteum hemorrhage was exclusively surgical, laparotomy or Laparoscopy and suturing, diathermy or wedge resection or even oophorectomy and salpingooophorectomy.…”

Section: Discussionmentioning

confidence: 99%

“…A conservative approach is reported in a few case reports of late. 6,8,11,12,14 In either case the treatment targets at preserving ovarian function as well as at eliminating the source of bleeding. The products that can be used to restore haemostatic parameters and to stop hemorrhage in the case of critical bleeding due to warfarin include Plasma Cell Concentrate (PCC), FFP, and vitamin K. When the patient is haemodynamically stable (systolic BP >90 mmHg) with hemoglobin values that keep being constant over 4-6 hours of monitoring, a conservative approach can be tried if diagnosis of corpus luteal hemorrhage is certain.…”

Section: Discussionmentioning

confidence: 99%

“…PCC cost less than rFVIIa, effect is immediate, volume of infusion is small and therefore there is no fluid overload, they are considered the treatment of choice for rapid reversal of oral anticoagulation. 6,8,10,13,14 However, PCC are not available in India. Consideration is also given to inhibiting ovulation in future and preventing ovulation bleed by use of OCP or progestins.…”

Section: Discussionmentioning

confidence: 99%

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Haemoperitoneum due to ruptured corpus luteum! managed conservatively-2 case reports and review of literature

Ara

Malik

Malla

2016

Int J Reprod Contracept Obstet Gynecol

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“…In addition, by suppressing ovulation, CHCs, DMPA, and possibly progestin-only pills can reduce the risk of ovarian hemorrhage. 47 It is important to note that adequate anticoagulant therapy is required to safely use CHCs and progestin-only therapies associated with an increased risk of VTEs. These agents should be discontinued before anticoagulants are stopped.…”

Section: Management Of Anticoagulantassociated Hmb Outpatient Managementmentioning

confidence: 99%

How I treat heavy menstrual bleeding associated with anticoagulants

Boonyawat

O’Brien

Bates

2017

Blood

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Anticoagulant-associated heavy menstrual bleeding (HMB) is an underrecognized but not uncommon problem in clinical practice. Premenopausal women should be advised of the potential effect of anticoagulant therapy on menstrual bleeding at the time of treatment initiation. Consequences of HMB should be assessed and treated on an ongoing basis. In the acute setting, the decision to withhold anticoagulants is based on an individual patient's risk of thrombosis and the severity of the bleeding. For women who require long-term anticoagulation, a levonorgestrel intrauterine system, tranexamic acid (during menstrual flow), high-dose progestin-only therapy, or combined hormonal contraceptives are effective for controlling HMB. The risk of thrombosis during anticoagulant therapy with these treatments is not well studied but is likely to be low. Selection of type of hormonal therapy is based on patient preference, other indications for and contraindications to therapy, adverse effect profile, and ongoing thrombotic risk factors. Women who do not respond to medical treatment or who do not wish to retain their fertility should be considered for surgical management.

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Conservative management of corpus luteum haemorrhage in patients on anticoagulation: a report of three cases and review of literature

Abstract: Selected patients with haemorrhage secondary to deranged coagulation can undergo conservative management in consultation with cardiologist and hematologist.

Cited by 25 publications

References 13 publications

Menstrual Abnormalities and Gynaecological Problems in Women on Anticoagulant and Antiplatelet Therapy: Management Options

Menstrual Abnormalities and Gynaecological Problems in Women on Anticoagulant and Antiplatelet Therapy: Management Options

Haemoperitoneum due to ruptured corpus luteum! managed conservatively-2 case reports and review of literature

How I treat heavy menstrual bleeding associated with anticoagulants

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