Severe hemorrhagic corpus luteum complicating anticoagulation in antiphospholipid syndrome

Abstract

Antiphospholipid syndrome (APS) is a disorder of coagulation that causes thrombosis as well as pregnancy-related complications, occurring due to the autoimmune production of antibodies against phospholipid. Full anticoagulation is the cornerstone therapy in patients with thrombosis history, and this can lead to major bleeding. During a 3-year period, 300 primary and secondary APS patients were followed up at the Rheumatology Division of the authors' University Hospital. Of them, 255 (85%) were women and 180 (60%) were of reproductive age. Three of them (1%) had severe hemorrhagic corpus luteum while receiving long-term anticoagulation treatment and are described in this report. All of them were taking warfarin, had elevated international normalized ratio (>4.0) and required prompt blood transfusion and emergency surgery. Therefore, we strongly recommend that all women with APS under anticoagulation should have ovulation suppressed with either intramuscular depot-medroxyprogesterone acetate or oral desogestrel.

Ovarian reserve in women with primary antiphospholipid syndrome

“…The median time of warfarin use was 5.05 years (0.7–12.9). Participants were excluded from the study if they were pregnant, breastfeeding, unwilling to participate in the study, had medical contraindications, possessed an increased risk of corpus luteum bleeding after stopping use of progestogen-only contraceptives, 9 underwent previous ovarian surgery, required systemic chemotherapy, underwent pelvic radiotherapy, were currently using a long-acting gonadotropin release hormone agonist (GnRH-a), presented with an additional autoimmune disease, or had an end-stage renal disease. None of them were under estrogen contraceptive during the study or anytime during their treatment.…”

“…None of our PAPS patients and controls had hypergonadotrophic amenorrhea, which would suggest primary ovarian insufficiency (high levels of FSH >40 IU/l and sustained amenorrhea). 9 The local ethics committee of our university hospital approved this study, and informed consent was obtained from all participants.…”

“…1,2 Likewise, it is known that aging, smoking and ovarian surgery decrease the quantity and quality of primordial follicles in the ovaries and, ultimately, the ovarian reserve (OR). 3,4 Conditions such as autoimmune oophoritis, 5,6 ovarian ischemia 7,8 and corpus luteum hemorrhage 9 may lead to diminished OR. Females suffering from PAPS are susceptible to the above-mentioned complications, yet the medical literature lacks information on how this relevant autoimmune disease affects the OR of these women.…”

Menstrual Abnormalities and Gynaecological Problems in Women on Anticoagulant and Antiplatelet Therapy: Management Options

“…Data on the safety of use of newer anticoagulants including dabigatran or rivaroxaban during pregnancy is not yet available. 3) Hemorrhagic ovarian cysts, which can be life-threatening, are estimated to affect 1% of women receiving anticoagulation medications [8]. 4) Pregnancy and the postpartum period increase women's risk of thrombosis and therefore require careful planning and awareness of the potential signs/symptoms of thrombotic events.…”

Avaliação da reserva ovariana em pacientes com síndrome antifosfolípide primária

“…Assim, estas duas condições, tempo e menstruação, remeteram-nos a uma atividade ovariana normal e, portanto, a um valor fidedigno de todos os hormônios, inclusive do HAM[66][67][68][69] .Este critério criou a principal restrição na seleção de nossa população. As pacientes com SAFP, que tinham risco aumentado de sangramento uterino e ovariano70 , tiveram que ser excluídas do estudo. Apesar de refletir em segurança (não houve nenhuma complicação hemorrágica ou gestação neste período), houve uma taxa de participação de 42% que, quando associada à baixa frequência da SAFP, resultou em uma amostra reduzida, a maior limitação do estudo.…”