Archive for the ‘Women and blood clots’ Category
Stephan Moll, MD writes… Interesting observations published in the last 2 weeks: Heavy menstrual bleeding appears to occur more commonly with Xarelto® than with warfarin [ref 1] and may be also more common with Xarelto® than with Eliquis® [ref 2]. Read the rest of this entry »
Stephan Moll, MD writes… Interesting and relevant publication this week [reference 1]. It is well known that estrogen–containing birth control methods (pills, vaginal rings, patches, injectables) increase the risk for DVT and PE. As women on blood thinners may have heavy menstrual bleeds, hormonal therapy may be considered to decrease the bleeding. Also, women on blood thinners may want to choose a method for contraception other than a progestin IUD (Mirena® IUD, Skyla® IUD).
The newly published study Read the rest of this entry »
Stephan Moll, MD writes… Women are at increased risk for blood clots (DVT, PE, stroke and heart attacks) during pregnancy and in the weeks after delivery. If the risk is high enough, then preventive blood thinners (anticoagulants) are recommended, such as in a woman with a history of a previous blood clot. Guidelines exist as to which woman should be considered for blood thinners (ACOG 2012 guideline; ref 1).
The period after delivery is a particularly high-risk period for forming blood clots. It has typically been defined as being the 6 weeks after giving birth. Therefore, if blood thinners are chosen after delivery, they are classically given for 6 weeks. A study recently published in the New England Journal of Medicine (ref 2) examined whether the risk for blood clots is increased only for 6 weeks postpartum or whether the risk persists beyond the first 6 weeks. Read the rest of this entry »
Dr. Stephan Moll writes… Skyla® is a new intrauterine device (IUD) birth control option, approved in February 2013 by the FDA. Skyla® is like a small version of the Mirena® IUD; it releases low doses of the hormone progestin to help the IUD prevent pregnancy. It has the following features: Read the rest of this entry »
Birth control pills, patches and rings typically contain an estrogen and a progestin component. It has long been known that estrogen-containing birth control preparations (pill, patch, ring) increase the risk for blood clots (DVT, PE). This risk is partially due to the estrogen. However, part of the risk for clots is also due to the type of progestin in these preparations. Read the rest of this entry »
A new guideline about the prevention, diagnosis, and treatment of DVT and PE associated with pregnancy was published today by ACOG (American College of Obstetricians and Gynecologists) in its respected series of Practice Bulletins. The bulletin also takes detailed reference to prevention of blood clots in pregnant women with thrombophilia. Read the rest of this entry »
The CDC today published recommendations on use of birth control methods for non-breast feeding women after child birth (full text is here). The key recommendations are as follows: Read the rest of this entry »
How common is pregnancy loss? What are the causes?
Pregnancy loss (= miscarriage) in the general population is common. Most losses occur in the first trimester. As many as 5 % of women have 2 or more early losses; 1-2 % have 3 or more early losses [ref 1]. Well established risk factors for pregnancy loss are: (a) advanced age of the mother, (b) anatomic abnormalities of the uterus (such as fibroids), (c) chromosome abnormalities of fetus, the mother or the father, (d) underlying diseases of the mother (endocrine, immunologic), (e) maternal hormonal unbalances. The acquired clotting disorder called “antiphospholipid antibody syndrome” is also a risk factor for pregnancy loss. The role of inherited clotting disorders (= thrombophilias) contributing to pregnancy loss is less clear. Read the rest of this entry »
It is well known that combination contraceptives (containing estrogens AND progestins) increase the risk for blood clots (venous thromboembolism = VTE). Relatively few data, however, have been published on progestin-only contraceptives, so that until recently it has not been clear whether they increase the risk for VTE or not. Read the rest of this entry »
Warfarin (coumadin®, Janotven®) and other blood thinners often increase the amount of bleeding during menses and sometimes the number of days that a woman bleeds. However, this does not happen in everyone – in some women there is no change in the bleeding pattern. In general, the more vaginal bleeding a woman has, the more cramping she experiences. Since warfarin may increase the vaginal bleeding, Read the rest of this entry »