Résumé
Backgroundanticoagulants cause abnormal uterine bleeding (AUB) in women of reproductive age with venous thromboembolism (VTE), but the safety profiles of oral anticoagulants (OACs) in this setting are unclear.Objectivesto analyzed the prevalence of AUB and quality of life (QoL) and compared in four groups (rivaroxaban, apixaban, vitamin K antagonists [VKA], and controls).Patients/Methods: the GENB-OAC study was a national, multicenter, observational, cross-sectional study conducted in 10 French hospitals during 2018–2022. The primary outcome was the proportion of women with major genital bleeding and/or clinically relevant non-major (CRNM) genital bleeding and/or Pictorial Blood Loss Assessment Charts (PBAC) score >100.Resultsoverall, 445 women were included: 122 on apixaban, 123 on rivaroxaban, 81 taking VKAs, and 119 healthy controls. The primary genital bleeding endpoint was significantly higher in OAC vs control group (94.8% vs 82.4%; P < .001) and the rivaroxaban or VKA vs apixaban group (96.7% or 97.5% vs 90.1%; P = .039 and P = .047). Major genital bleeding was similar in the apixaban and rivaroxaban groups, but menstruation ≥8 days, CRNM bleeding, and PBAC >100 were significantly higher in the rivaroxaban vs apixaban group. QoL was significantly lower in the OAC vs control group, but similar in the three OAC groups.ConclusionsAUB is frequent in women of reproductive age. OACs increase AUB and impact women’s QoL. Apixaban is associated with less AUB than rivaroxaban or VKAs without a QoL difference. An international consensus is necessary to help clinicians detect and treat AUB in OAC users. 1.Oral anticoagulants increase abnormal uterine bleeding in childbearing women. 2.Oral anticoagulants worsen quality of life due to abnormal uterine bleeding. 3.Apixaban causes less abnormal uterine bleeding than rivaroxaban or VKAs. 4.A simple definition is needed to detect and manage abnormal uterine bleeding.