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. 2025 Jan;23(1):23-26.
doi: 10.1016/j.jtha.2024.10.019. Epub 2024 Oct 28.

Déjà vu all over again: a recurrent flaw in anticoagulant study design

Bethany Samuelson Bannow  1 , Alison Edelman  2 , Marc Carrier  3
Affiliations

Déjà vu all over again: a recurrent flaw in anticoagulant study design

Bethany Samuelson Bannow et al. J Thromb Haemost. 2025 Jan.

Abstract

The availability of direct oral anticoagulants rapidly changed the landscape of anticoagulation between 2010 and the present. Randomized controlled trials demonstrating efficacy with similar or superior safety compared with warfarin led to the widespread use of direct oral anticoagulants in male and female patients of all ages. Years later, postmarketing data demonstrated a markedly increased rate of heavy menstrual bleeding (HMB) with rivaroxaban that had gone undetected in registry trials. Factor (F)XI inhibitors are currently being investigated as another alternative to available anticoagulation agents. While generally mild, the phenotype of inherited FXI deficiency includes bleeding in tissues with enhanced fibrinolysis, including HMB. Thus, we aimed to perform a systematic review of published studies on FXI inhibitors in order to estimate rates of HMB. However, we found that few studies included menstruating individuals, and even fewer specifically reported on uterine bleeding, highlighting once again a flaw in our approach to conducting trials of new anticoagulants.

Keywords: anticoagulant agents; clinical trials; menorrhagia; menstruation; randomized; uterine bleeding.

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Conflict of interest statement

Declaration of competing interests There are no competing interests to disclose.

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