Common clinical scenarios of hormone-related VTE and key clinical considerations
| Clinical setting . | Key clinical considerations . | Further reading . |
|---|---|---|
| Hormonal contraceptives | • after start of anticoagulant therapy, the risk of abnormal uterine bleeding/heavy menstrual bleeding is high, and cessation of hormonal contraceptives likely further increases bleeding • need for adequate contraception during oral anticoagulant treatment • indications for use not only include prevention of pregnancy but may also include polycystic ovary syndrome, abnormal uterine bleeding, and endometriosis • indication for thromboprophylaxis in future pregnancy | 1,34 |
| Assisted reproductive technology | • desire for parenthood is central for many patients | 18 |
| Pregnancy and postpartum period | • manage health of both mother and unborn child/newborn • low-molecular-weight heparins are the first choice of treatment during pregnancy; very common side effects include bruising and skin allergies • for the prevention and management of VTE, DOACs and VKAsa are contraindicated during pregnancy due to concerns for the unborn child • challenges of anticoagulant management around delivery and neuraxial anesthesia • some anticoagulants are contraindicated during breastfeeding • consequences for thromboprophylaxis in future pregnancy | 18 |
| Hormone replacement therapy | • indications for use are generally well-being and quality of life | 34 |
| Gender-affirming therapy | • indication for use is crucial for well-being and quality of life | 35 |
| Hormone therapy in oncology | • likely has an impact on the oncological management plan and prognosis | 36 |
| Clinical setting . | Key clinical considerations . | Further reading . |
|---|---|---|
| Hormonal contraceptives | • after start of anticoagulant therapy, the risk of abnormal uterine bleeding/heavy menstrual bleeding is high, and cessation of hormonal contraceptives likely further increases bleeding • need for adequate contraception during oral anticoagulant treatment • indications for use not only include prevention of pregnancy but may also include polycystic ovary syndrome, abnormal uterine bleeding, and endometriosis • indication for thromboprophylaxis in future pregnancy | 1,34 |
| Assisted reproductive technology | • desire for parenthood is central for many patients | 18 |
| Pregnancy and postpartum period | • manage health of both mother and unborn child/newborn • low-molecular-weight heparins are the first choice of treatment during pregnancy; very common side effects include bruising and skin allergies • for the prevention and management of VTE, DOACs and VKAsa are contraindicated during pregnancy due to concerns for the unborn child • challenges of anticoagulant management around delivery and neuraxial anesthesia • some anticoagulants are contraindicated during breastfeeding • consequences for thromboprophylaxis in future pregnancy | 18 |
| Hormone replacement therapy | • indications for use are generally well-being and quality of life | 34 |
| Gender-affirming therapy | • indication for use is crucial for well-being and quality of life | 35 |
| Hormone therapy in oncology | • likely has an impact on the oncological management plan and prognosis | 36 |
VKAs are considered on a case-by-case basis during pregnancy in women with mechanical heart valves and high thrombotic risk.