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Heavy menstrual bleeding: case report A 47-year-old woman developed heavy menstrual bleeding during treatment with aspirin and clopidogrel [durations of treatments to reaction onset not stated]. The woman (G4, P4) presented to the emergency service with 3 day history of heavy vaginal bleeding. Subsequent physical examination showed that she had profuse vaginal bleeding with large clots in the vagina coming from the cervical os. A transvaginal sonography showed an endometrial thickness of 8.4mm and sub-mucous leiomyoma with a diameter of 34mm in the endometrial cavity. Her vital signs included BP 140/85mm Hg, pulse rate 72 beats/min, a SpO2 of 96% and body temperature 36.3°C. Blood test showed haemoglobin 8.9 g/dL, haematocrit 27%, platelet count 457 000mm3, prothrombin time 14.1 seconds, international normalized ratio of 1.07 and activated partial thromboplastin time 22.7 seconds. Prolonged bleeding time was 17 seconds. She had a significant history of dilatation and curettage (D&C) for menometrorrhagia a month ago in another hospital. At that time, histopathology showed endometrial polyp and her haemoglobin level was 6.9 g/dL, for which she had received 2 units of red blood cell infusion following D&C. After 1 month of the procedure, she presented with complaint of abnormal uterine bleeding. At that time, levonorgestrel-containing intrauterine device (Mirena) was placed. After 3 days of device insertion, she presented with lower abdominal pain. Subsequently, dislocated levonorgestrel device was removed. As she had been receiving anticoagulation therapy, she was referred to the emergency service. She had a history of myocardial infarction, hypothyroidism and asthma. She had coronary artery bypass surgery twice in 4 years followed by coronary artery stent placement. She had been receiving clopidogrel 75 mg/day and aspirin [acetylsalicylic acid] 100 mg/day [routes not stated]. Anamnesis revealed that she had an irregular visit to the cardiology department for her cardiac disease and her medical therapy. Following her presentation to the emergency department, a silicone Foley catheter was used as an emergency treatment for active massive uterine bleeding. After the procedure, bleeding stopped abruptly. Subsequently, she became hemodynamically stable. Due to the use of clopidogrel and aspirin, total laparoscopic hysterectomy was performed on hospital day 5. Until the surgery, she received ceftriaxone. Postoperative period was uneventful. She was discharged with only aspirin with the recommendation of the cardiology department. Soykan Y, et al. Successful management of acute heavy menstrual bleeding with foley's catheter of a patient under combined antiplatelet therapy for cardiac disease: A 803518516 case report. Gazi Medical Journal 31: 683-685, No. 4, Sep 2020. Available from: URL: http://doi.org/10.12996/GMJ.2020.159

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Reactions 5 Dec 2020 No. 1833