Assessment of Coagulation Parameters in Women Affected by Endometriosis: Validation Study and Systematic Review of the Literature

Abstract

The presence of endometriosis determines an inflammatory response locally. The objective of this validation study and systematic review was to assess systemic levels of coagulation and inflammatory parameters in women with or without the disease. We conducted a retrospective analysis of a database prospectively collected from January 2017 to February 2020 including n = 572 women who underwent laparoscopic surgery for endometriosis (cases, n = 324) or other benign gynecologic diseases (controls, n = 248). Inflammatory markers and coagulation parameters were determined. An advanced systematic search of the literature on the same parameters was conducted up to April 2020. A significantly higher neutrophil count was found in endometriosis patients. Patients with endometriomas and stage III–IV disease had a significantly lower absolute lymphocyte count and shortened activated partial thromboplastin time (aPTT) values. In the final regression model, aPTT retained significant predictive value for stage III–IV endometriosis (odds ratio (OR) = 0.002, 95% confidence interval (CI) = 0.00–0.445; p = 0.024). Results from the n = 14 included studies in the systematic review are characterized by a high variability, but some consistency has been found for alterations in thrombin time, platelet-to-lymphocyte ratio, and neutrophil count associated with endometriosis. Modest systemic changes of some inflammatory and coagulation parameters are associated with endometriosis. Indeed, all the modifications detected are still within the normal reference intervals, explaining the high heterogeneity among studies.

Multi‐omics analysis reveals the interaction between the complement system and the coagulation cascade in the development of endometriosis

“…The close association of coagulation and inflammatory conditions has been known for a long time 8 . Current studies have showed that women with EMS appeared to be in a state of hypercoagulability and this coagulation dysfunction potentially attributed to the inflammatory nature of the ectopic lesions 9 – 11 . In recent years, the massive data of gene expression profile generated from high-throughput sequencing technology make it possible for us to explore the intrinsic mechanism of diseases at the molecular level 12 .…”

Ovarian clear cell cancer associated with Trousseau syndrome: A case report and literature review

“…[ 11 ] The endometriosis tumor microenvironment is characterized by chronic inflammation and hypoxic conditions, and previous studies have shown that endometriosis patients are in a hypercoagulable state like OCCC. [ 9 , 12 ] Otherwise, angiogenesis, immune escape and metastasis facilitate tumor development, and all these processes involve activation of the coagulation system. Coagulation factors can participate in tumor progression through coagulation-dependent pathways (including fibrin formation, platelet recruitment, immunomodulatory responses, and tissue factor particle secretion) and non-dependent pathways (intracellular signaling).…”

Endometriosis and cardiovascular disease

“…A review of the literature discloses several studies reporting an association between endometriosis and a procoagulant state. High tissue factor expression, 104 increased procoagulant microparticle levels, 39 and modest systemic changes of coagulation parameters 105 have been reported, but these variables did not translate into increased VTE rates. To date, no studies have shown that endometriosis is associated with an increased risk of VTE except during pregnancy.…”