Abstract Number: PB1581
Meeting: ISTH 2020 Congress
Background: Women with VWD have increased risk of gynaecological complications during haemostatic challenges of ovulation and menstruation.
Aims: Review bleeding symptoms and their management in women with moderate/severe VWD.
Methods: Retrospective cohort analysis.
All patients registered at Katharine Dormandy Haemophilia and Thrombosis Centre, Royal Free Hospital.
Information collected from electronic patient records.
Results: 67 women were identified; all reported heavy menstrual bleeding (HMB). 38% experienced periods lasting 7-14 days and 25% bled up-to 2-6 weeks, with post-treatment improvement to «7 days in 72%.
Baseline PBAC scores were 1056 and 393 for severe and moderate cohorts, respectively, with post-treatment improvement to 393 and 115.
All underwent pelvic ultrasound and further 25% had hysteroscopic assessment, revealing 3 cases of submucosal fibroids and 3 cases of endometrial polyps.
11% improvement in haemoglobin and 69% in ferritin levels observed post-treatment.
Table 1 outlines HMB treatment:
|FIRST LINE TREATMENT||Number treated (n=)||Satisfactory outcome (n=)|
|Non-hormonal – TXA/ DDAVP||16 / 2||1 TXA case|
|Hormonal – CHC + TXA||46 (11 had Mirena coil inserted on a later date)||28 All Mirena cases|
|Clotting factor concentrate (CFC) – CHC+TXA+CFC||3||2|
|SECOND LINE TREATMENT|
|Non-hormonal – TXA+DDAVP – TXA+CFC||DDAVP=6 CFC= 4||4 CFC cases|
|Hormonal – Extended CHC (2-6 months) – Mirena coil||5 8||3 All Mirena coil cases|
|Surgical – Endometrial ablation + Mirena coil||2||2|
|THIRD LINE TREATMENT|
|SURGICAL – Endeometrial ablation – Hysterectomy||3 3||3 3|
[Table 1. Management of heavy menstrual bleeding]
TXA/ DDAVP first-line treatment (FLT) in adolsecents did not control period-length. In those with suboptimal response to FLT, 50% reported shortened periods with addition of CHC but had persistent HMB. Other 50% reported excessive, unscheduled breakthrough bleeding associated with history of non-compliance.
TXA/ DDAVP use in women had no effect in reducing period-length. Addition of combined hormonal contraception (CHC) yielded 79% symptom-control; however relapse was observed with prolonged use (>3 years) or climacteric changes in 22%.
Mirena-coil with 6 months CHC+TXA cover provided 100% long-term symptom-control (n=19).
69% of second-line treatment failures were associated with non-compliance due to concerns regarding long-term hormonal therapy impacting fertility, causing hair loss or weight gain.
There was no significant difference in haemostatic parameters between responders and non-responders to FLT (Table 2.)
[Table 2. Mean haemostatic parameter levels]
Haemorrhagic ovarian cysts encountered in 64% severe and 12% moderate cases. All managed conservatively with TXA and CHC to suppress ovulation; 38% required clotting-factor concentrate.
Conclusions: Management of bleeding complications requires combination of hormonal and haemostatic treatment.
To cite this abstract in AMA style:Turan O, Epstein A, Pollard D, Abdul-Kadir R. Gynaecological Problems, Management and Outcomes in Women with Moderate and Severe von Willebrand Disease (VWD) [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/gynaecological-problems-management-and-outcomes-in-women-with-moderate-and-severe-von-willebrand-disease-vwd/. Accessed January 23, 2022.
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