Abstract No. 415 Uterine artery embolization for anticoagulant-associated uterine bleeding

Abstract

Abnormal uterine bleeding (AUB) affects up to two thirds of women on anticoagulation (AC) therapy. In women on AC for venous thromboembolism (VTE), AUB is linked to recurrent VTE, likely due to interrupted therapy. Treatment options for anticoagulant-associated AUB (AA-AUB) are limited, as estrogen-containing treatments increase thrombotic risk and endometrial ablation or hysterectomy lead to infertility. While uterine artery embolization (UAE) is a well-established treatment for symptomatic fibroids, its role in acute AA-AUB is limited to case reports. This study describes a series of patients who underwent UAE for the treatment of acute AA-AUB, focusing on technique, safety and outcomes. The institutional review board approved this retrospective review on 16 patients who underwent UAE for acute AA-AUB at a single academic medical center between Feb 2014 and Feb 2019. Three board-certified interventional radiologists performed UAE cases using 500-700 micron tris-acryl gelatin microspheres (Merit Medical Systems). In one case, tris-acryl gelatin microspheres were used in combination with Gelfoam. Medical, surgical, and radiologic records were reviewed. Statistical analysis were performed using MATLAB version R2018b (Mathworks). 16 patients were included with mean age 42 ± 7, on warfarin (38%), heparin drip (38%), or NOACs (25%). All patients demonstrated concurrent fibroids and/or adenomyosis and no patient had known endometrial malignancy. VTE, due to various etiologies, was the most common indication (88%) for AC. Cessation of acute AA-AUB was noted in the short term, defined as 3 days post-UAE, in 15 (94%) patients. 2 patients (12.5%) ultimately underwent hysterectomy due to failure of UAE to control AA-AUB in either the short or long term. Among patients who did not undergo hysterectomy for whom follow-up data was available, 9 (90%) maintained menses post-UAE. All patients were able to re-initiate or continue anticoagulation following UAE. UAE is an effective treatment strategy for acute AA-AUB. As an initial alternative to hysterectomy, endometrial ablation, or medical management, UAE allows patients to preserve menses and continue anticoagulation.Tabled 1Demographics Total cases16 Age (years)42 ± 7Indication for anticoagulation Cardiac valve prothesis1 Coronary arterial stent1 Venous thromboembolism14Timing of medical management of AA-AUB Concurrent with UAE7 Failure leading to UAE5 Not attempted4Anticoagulation post-UAE Re-initiated (previously held)6 Continued (not previously held)10 Stopped0Cessation of AUB post-UAE Resolved in short and long term10 Resolved in short term only; long term control with conservative or medical management3 Resolved in short term only; long term control with hysterectomy1 Resolved in short term; unable to assess long term efficacy due to hysterectomy for other indication1 Did not resolve, leading to hysterectomy1Loss of menses post-UAE No9 Yes1 N/A (hysterectomy shortly after UAE)2 N/A (inadequate follow up)4 Open table in a new tab