Further Evidence for Hypercoagulability in Women With Ovarian Endometriomas

Abstract

Our previous studies have shown that platelets play a crucial role in the development of endometriosis, and women with endometriosis appear to be in a state of hypercoagulability. However, a recent study could only replicate part of our previous finding, casting doubts on this notion. We further investigated this question through a cross-sectional study by measuring additional coagulation factors in women with and without endometriosis. To this end, we conducted a cross-sectional study of 100 women with laparoscopically and pathologically diagnosed ovarian endometriomas (OMA) and another 100 women without endometriosis. The platelet count; platelet activation rate; maximum platelet aggregation rate; plasma levels of D-dimer, fibrinogen, fibrin degradation products (FDPs), plasma soluble P-selectin (sP-sel), and prothrombin fragment 1þ2 (F1þ2); prothrombin time; thrombin time (TT); and activated partial thromboplastin time were measured before surgery and 3 months after surgery, and their clinical data were recorded. These measurements were also performed in control patients. We found that, compared with controls, women with OMA had a significantly higher platelet activation rate and platelet aggregation rate, elevated plasma D-dimer, fibrinogen, FDPs, sP-sel, and F1þ2 levels as well as shortened TT. Remarkably, TT was prolonged, and all the other coagulation measurements, except plasma fibrinogen level, were significantly reduced 3 months after surgical removal of endometriotic lesions. Thus, our study provides another piece of evidence that endometriosis is a hypercoagulable disease, and anticoagulation therapy may hold promises in treating endometriosis.

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

“…Three studies have evaluated differences in INR between patients with and without endometriosis finding no difference [12,14,29]. Four studies have addressed aPTT [12,14,29,30], and two of them have reported shortened aPTT in cases when compared to controls [12,14]. In particular, in our previous study, considering the various manifestations of endometriosis separately, we found that women with ovarian disease had shortened aPTT values in comparison to controls and women with SPE and DIE.…”

“…Opposite results were obtained by Kim and coworkers, since PLC was not significantly different in severe endometriosis [27]. Three studies have evaluated PT [12,29,30], and only Ding and coworkers showed a significantly shorter time in the OMA group compared to a benign cyst group and a control group [30]. Conversely, for TT, three studies [12,29,30] out of four showed significantly shorter values in patients affected by OMAs compared to control groups [12,14,29,30].…”

“…Conversely, for TT, three studies [12,29,30] out of four showed significantly shorter values in patients affected by OMAs compared to control groups [12,14,29,30]. Three studies have evaluated differences in INR between patients with and without endometriosis finding no difference [12,14,29]. Four studies have addressed aPTT [12,14,29,30], and two of them have reported shortened aPTT in cases when compared to controls [12,14].…”

“…Three studies have evaluated PT [12,29,30], and only Ding and coworkers showed a significantly shorter time in the OMA group compared to a benign cyst group and a control group [30]. Conversely, for TT, three studies [12,29,30] out of four showed significantly shorter values in patients affected by OMAs compared to control groups [12,14,29,30]. Three studies have evaluated differences in INR between patients with and without endometriosis finding no difference [12,14,29].…”

“…Indeed, all the modifications of the coagulation process detected are still within the normal reference intervals. Interestingly, Ding and coworkers have shown that three months after surgery for the removal of endometriotic lesions, the coagulation measurements were all significantly changed, suggesting a possible role for active endometriosis in the alterations of coagulation parameters, either locally or systemically [29].…”