Uterine fibroids and the problem of deep vein thrombosis of the lower extremities. View of a vascular specialist and hematologist

Authors

DOI:

https://doi.org/10.18370/2309-4117.2022.66.82-88

Keywords:

uterine fibroids, menorrhagia, deep vein thrombosis, endovascular uterine artery embolization, anticoagulant therapy

Abstract

The article provides clinical data and an algorithm for the management of patients with symptomatic uterine fibroids complicated by metrorrhagia and venous thrombotic events.
Objective: to improve the treatment of patients with uterine fibroids complicated by abnormal menstrual bleeding, anemia and venous thrombotic events due to the implementation of the developed algorithm for diagnosis and treatment.
Materials and methods. The study included 15 patients aged 32–49 years with a diagnosis of uterine fibroids with menorrhagia and iron deficiency anemia, complicated by deep vein thrombosis of the lower extremities. Thromboembolism of small branches of the pulmonary artery was diagnosed in 5 (30%) of these patients.
The examination algorithm included general clinical tests (general blood and urine analysis, biochemical blood analysis, coagulogram), evaluation of the D-dimer, soluble fibrin monomer complexes, ultrasound of the pelvic organs, ultrasound duplex scanning of the veins of lower extremities, electrocardiography, echocardiography, multispiral computed tomography of chest. All patients underwent endometrial biopsy to exclude oncological pathology.
The proposed treatment included: uterine artery embolization to stop bleeding, correction of hemostatic parameters, and anticoagulant therapy of venous thrombotic events after stopping bleeding.
Results. Bleeding was stopped in all 100% of patients after endovascular uterine artery embolization. The duration of anticoagulant therapy depended on the causes of venous thrombosis and was at least 3–6 months; it was extended for more than 6 months if there were concomitant risk factors.
Conclusions. Uterine artery embolization allows quickly and reliably stopping bleeding and immediately starting adequate anticoagulant therapy for venous thrombotic events.

Author Biographies

L.M. Chernukha, O.O. Shalimov National Institute of Surgery and Transplantology, Kyiv

MD, professor, chief researcher, Department of Vascular Surgery

O.A. Vlasenko, Educational and Scientific Center “Institute of Biology and Medicine” of Taras Shevchenko National University of Kyiv, Kyiv

PhD, assistant, Internal Medicine Department

I.O. Rodionova, Educational and Scientific Center “Institute of Biology and Medicine”, Taras Shevchenko National University of Kyiv, Kyiv

MD, associate professor, Department of Internal Medicine

Y.P. Markovets, Educational and Scientific Center “Institute of Biology and Medicine”, Taras Shevchenko National University of Kyiv, Kyiv

Assistant, Department of Internal Medicine

D.A. Vlasenko, Educational and Scientific Center “Institute of Biology and Medicine”, Taras Shevchenko National University of Kyiv, Kyiv

Student

H.H. Vlaikov, O.O. Shalimov National Institute of Surgery and Transplantology, Kyiv

PhD, senior researcher, Department of Vascular Surgery

References

  1. Evans, P., Brunsell, S. “Uterine fibroid tumors: diagnosis and treatment.” Am Fam Physician 75.10 (2007): 1503–8.
  2. Katz, T.A., Yang, Q., Treviño, L.S., et al. “Endocrine-disrupting chemicals and uterine fibroids.” Fertil Steril 106.4 (2016): 967–77. DOI: 10.1016/j.fertnstert.2016.08.023
  3. Tatarchuk, T.F., Cossey, N.V., Redko, N.A. “Antianemic therapy as an important component of treatment of uterine leiomyoma.” Reproductive endocrinology 14 (2013): 7–16.
  4. Alateeq, A.M., Alshammari, H.A., Alsaif, A.M. “Iron Deficiency Anemia With a Life-Threatening Low Hemoglobin Level.” Cureus 13.12 (2021): e20150. DOI: 10.7759/cureus.20150
  5. Falcone, M., Serra, P. “Massive pulmonary embolism in a woman with leiomyomatous uterus causing pelvic deep venous thrombosis.” Ann Ital Med Int 20.2 (2005): 104–7.
  6. Khademvatani, K., Rezaei, Y., Kerachian, A., et al. “Acute pulmonary embolism caused by enlarged uterine leiomyoma: a rare presentation.” Am J Case Rep 15 (2014): 300–3. DOI: 10.12659/AJCR.890607
  7. Podduturi, V., Armstrong-Briley, D.R., Guileyardo, J.M. “Sudden Death by Pulmonary Thromboembolism due to a Large Uterine Leiomyoma with a Parasitic Vein to the Mesentery.” Case Rep Obstet Gynecol (2014): 181265. DOI: 10.1155/2014/181265
  8. Konstantinides, S.V., Meyer, G., Becattini, C., et al. “2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).” Eur Heart J 41.4 (2020): 543–603. DOI: 10.1093/eurheartj/ehz405
  9. Costa, K.R., Metzger, P.B. “Endovascular treatment of uterine myomatosis: a systematic review.” J Vasc Bras 19 (2020): e20190149. DOI: 10.1590/1677-5449.190149
  10. Hapugoda, S. “Uterine leiomyoma (fibroid) classification system (illustration). Case study.” Radiopaedia.org. (accessed on 09 Jan 2022). DOI: 10.53347/rID-62908.
  11. Gialeraki, A., Valsami, S., Pittaras, T., et al. “Oral Contraceptives and HRT Risk of Thrombosis.” Clin Appl Thromb Hemost 24.2 (2018): 217–25. DOI: 10.1177/1076029616683802
  12. Casteleyn I., Joosten, E. “Evaluation of Parenteral Iron Therapy in Ambulatory Older Adults with Iron Deficiency Anaemia.” Acta Haematol 138 (2017): 221–2. DOI: 10.1159/000484654
  13. Breymann, C., Auerbach, M. “Iron deficiency in gynecology and obstetrics: clinical implications and management.” Hematology Am Soc Hematol Educ Program 2017.1 (2017): 152–9. DOI: 10.1182/asheducation-2017.1.152
  14. Heit, J.A., Cunningham, J.M., Petterson, T.M., et al. “Genetic variation within the anticoagulant, procoagulant, fibrinolytic and innate immunity pathways as risk factors for venous thromboembolism.” J Thromb Haemost 9 (2011): 1133–42.
  15. Zhang, G., Yu, X., Zhu, L., et al. “Preoperative clinical characteristics scoring system for differentiating uterine leiomyosarcoma from fibroid.” BMC Cancer 20 (2020): 514.
  16. Verhaeghe, R., DeMoerloose, P., Eikenboom, J.C., et al. Genetic and asquired risk factors of venous thromboembolism. In: Pulmonary Vascular Pathology: A Clinical Update. Eds. Demedts, M., Delcroix, M., Verhaeghe, R., Verleden, G.M. EurRespSoc (2004): 9.
  17. Colmanetal, R.W. Hemostasis and Thrombosis: Basis Principles and Clinical Practice. Ed. Robert W. Colmanetal. FourthEdition (2001).
  18. Hvas, A.M., Larsen, J.B., Pasalic, L. “Thrombosis and hemostasis in surgery.” Semin Thromb Hemost 43.07 (2017): 649–52.
  19. Abou-Ismail, M.Y., Citla Sridhar, D., Nayak, L. “Estrogen and thrombosis: A bench to bedside review.” Thrombosis Res 192 (2020): 40–51. DOI: 10.1016/j.thromres.2020.05.008
  20. Fruzzetti, F., Cagnacci, A. “Venous Thrombosis and Hormonal Contraception: What’s New With Estradiol-Based Hormonal Contraceptives?” Open Access J Contracept 9 (2020): 75–9. DOI: 10.2147/OAJC.S179673
  21. Croles, F.N., Nasserinejad, K., Duvekot, J.J., et al. “Pregnancy, thrombophilia, and the risk of a first venous thrombosis: systematic review and bayesian metaanalysis.” BMJ (3592017): j4452.
  22. Dan, K. “Thrombocytosis in iron deficiency anemia.” Intern Med 44.10 (2005): 1025–6. DOI: 10.2169/internalmedicine.44.1025
  23. Rokkam, V.R., Kotagiri, R. Secondary Thrombocytosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
  24. Pitliya, A., Ahmad, A., Shaukat, H. “Commentary: Association of Anemia with Venous Thromboembolism in Acutely Ill Hospitalized Patients: An APEX Trial Substudy.” Journal of Lung Health and Diseases (2018). DOI: 10.29245/2689-999X/2017/3.1133
  25. Gialeraki, A., Valsami, S., Pittaras, T., et al. “Oral contraceptives and HRT Risk of Thrombosis.” Clin Appl Thromb Hemost 24.2 (2018): 217–5.
  26. Tang, X., Zhang, Z., Fang, M., et al. “Transferrin plays a central role in coagulation balance by interacting with clotting factors.” Cell Research (2019): 119–32.
  27. Batur Caglayan, H.Z., Nazliel, B., Irkec, C., et al. “Iron-Deficiency Anemia Leading to Transient Ischemic Attacks due to Intraluminal Carotid Artery Thrombus.” Case Rep Neurol Med (2013): 813415.
  28. Chang, Y.L., Hung, S.H., Ling, W., et al. “Association between Ischemic Stroke and Iron-Deficiency Anemia: A Population-Based Study.” PLoS One 8.12 (2013): e82952. DOI: 10.1371/journal.pone.0082952
  29. Horan, J.T., Francis, C.W. “Fibrin degradation products, fibrin monomer and soluble fibrin in disseminated intravascular coagulation.” Semin Thromb Hemost 27.6 (2001): 657–66. DOI: 10.1055/s-2001-18870
  30. Di Micco, P., D’Uva, M., Strina, I., et al. “The role of d-dimer as first marker of thrombophilia in women affected by sterility: implications in pathophysiology and diagnosis of thrombophilia induced sterility.” J Transl Med 2.1 (2004): 38. DOI: 10.1186/1479-5876-2-38
  31. Ramanan, S., Chapman-Wardy, J., Watson, R. “Bleeding versus Clotting: A Complex Case of a Large Fibroid Uterus Causing Menorrhagia and a DVT.” Case Rep Obstet Gynecol 2016 (2016): 4169565. DOI: 10.1155/2016/4169565
  32. Amin, T.N., Cohen, H., Wong, M., et al. “The Natural History of Uterine Venous Plexus Thrombosis.” Diagnostics 11.8 (2021): 1338. DOI: 10.3390/diagnostics11081338
  33. Practice Committee of the American Society for Reproductive Medicine. “Combined hormonal contraception and the risk of venous thromboembolism: a guideline.” Fertil Steril 107 (2017): 43–51. DOI: 10.1016/j.fertnstert.2016.09.027

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Published

2022-08-10

How to Cite

Chernukha, L., Vlasenko, O., Rodionova, I., Markovets, Y., Vlasenko, D., & Vlaikov, H. (2022). Uterine fibroids and the problem of deep vein thrombosis of the lower extremities. View of a vascular specialist and hematologist. REPRODUCTIVE ENDOCRINOLOGY, (66), 82–88. https://doi.org/10.18370/2309-4117.2022.66.82-88

Issue

No. 66 (2022)

Section

Tumors and pretumoral pathology

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Copyright (c) 2022 Л.М. Чернуха, О.А. Власенко, І.О. Родіонова, Є.П. Марковець, Д.А. Власенко, Г.Г. Влайков

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