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Weighing risk and centering patients within clinical guidelines

      We commend Dr. Lee et al. for presenting thorough guidelines regarding abortion care for patients with bleeding disorders or current use of anticoagulation [
      • Lee JK
      • Zimrin AB
      • Sufrin C.
      Society of Family Planning clinical recommendations: Management of individuals with bleeding or thrombotic disorders undergoing abortion.
      ]. While the authors provide an excellent summary of the research to date, the paper highlights the need for additional research, as many of the recommendations are based on expert opinion, rather than high quality evidence.
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      References

        • Lee JK
        • Zimrin AB
        • Sufrin C.
        Society of Family Planning clinical recommendations: Management of individuals with bleeding or thrombotic disorders undergoing abortion.
        Contraception. 2021; (Published online)https://doi.org/10.1016/j.contraception.2021.03.016
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        Significant adverse events and outcomes after medical abortion.
        Obstet Gynecol. 2013; 121: 166-171
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        • Desai S
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        • Weitz TA
        • Grossman D
        • Anderson P
        • et al.
        Incidence of Emergency Department Visits and Complications After Abortion.
        Obstetrics & Gynecology. 2015; 125: 175-183
        • Upadhyay UD
        • Schroeder R
        • Roberts SCM.
        Adoption of no-test and telehealth medication abortion care among independent abortion providers in response to COVID-19.
        Contraception: X. 2020; 2100049
        • Bannow BT
        • Chi V
        • Sochacki P
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        • Edelman A
        Heavy menstrual bleeding in women on oral anticoagulants.
        Thromb Res. 2021; 197: 114-119

      Linked Article

      • In reply to LTE: “Weighing risks and centering patients within clinical guidelines”
        ContraceptionVol. 104Issue 6
        • Preview
          We thank Drs. Lapedis, Ray, and Narayana for their feedback and agree that the recommendation regarding preference for surgical/procedural abortion over medication abortion in this population is based on consensus and expert opinion. Our intent with the recommendation was to provide more clinical direction in these often-difficult patient scenarios. Our intent was not to restrict options or to create obstacles to making patient-centered decisions and we feel our wording allows flexibility for the provider to offer other treatment options.
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