26. Venous Thromboembolism Among Concurrent Users of Combined Hormonal Contraceptive and Antifibrinolytics in Adolescents with Heavy Menstrual Bleeding

Abstract

<h3>Background</h3> Causes for heavy menstrual bleeding (HMB) vary from anovulatory cycles to a bleeding disorder. Treatments for HMB include hormonal and non-hormonal options. Frequently, combined hormonal contraceptives (CHC) are utilized first to control HMB. Venous thromboembolism (VTE) is a rare complication associated with the use of CHC. In adolescents with HMB refractory to CHC, antifibrinolytics (AF) may be used as adjunctive treatment. Concurrent use of CHC+AF theoretically increases risk of VTE, although no current studies have investigated this. The primary objective of this study was to investigate whether concurrent use of AF+CHC to treat HMB in adolescents results in increased VTE. <h3>Methods</h3> IRB approval was obtained to conduct this retrospective chart review at a single institution. ICD10 codes were utilized to identify patients <21 years of age with a diagnosis of HMB. Pharmacy data were utilized to identify those who had medication prescriptions for any CHC and/or AF. Basic demographics were recorded, along with medical history, CHC and AF prescribed. Primary endpoints assessed VTE complications from use of CHC and/or AF. Descriptive statistics were utilized, along with T-Tests. <h3>Results</h3> Chart review identified 2130 HMB patients using CHC and/or AF between 1/2010-12/2019. 470 used AF, 1669 CHC and 91 used both concurrently. The mean age (years) in each group was 18.9 ± 3.1 years (AF), 19.4 ± 3.0 years (CHC), and 19.3 ± 3.0 years (AF+CHC) respectively. The population was diverse. Of 2130 patients, 108 had hyperlipidemia. Mean BMI of AF or CHC users was 24.9, 9% had a personal/family history of bleeding disorder, and 3.8% reported a family history of unprovoked VTE in first/second generation relative. Mean time on therapy was 984 days (CHC), 132 days (AF), and 117 days (CHC+AF). Of CHC users 2% were on ultra-low dose pills, 90% low dose pills, 7% high dose pills, and 12.7% patches. There were no CHC ring users. There were no VTE events in the CHC or CHC+AF groups. There was one VTE event in the AF group. This patient had a remote VTE due to lupus and Factor V Leiden. She was anticoagulated and had IVC filter in place. HMB resulted from anticoagulation that was unresponsive to progesterone therapy alone. Hematology then allowed for use of AF, which subsequently controlled her HMB without recurrent VTE. <h3>Conclusions</h3> The incidence of VTE was low among adolescents with HMB (0.04%). We found no cases of VTE among users of CHC+AF. Screening for thrombophilia risk factors is important, and our study suggests CHC+AF does not result in increased risk of VTE among adolescents with HMB.