Venous thromboembolism and adenomyosis: A retrospective review

Abstract

Objectives: The objective of the study was to evaluate the incidence of venous thromboembolism (VTE) in patients who have been admitted for adenomyosis at our institute and describe their clinical characteristics and management. Materials and Methods: A retrospective review of the medical records of all patients who were admitted to the gynecology ward between January 2015 and August 2016 was conducted, and all patients who had adenomyosis were included in this study. Clinical details that were evaluated included age, parity, body mass index, significant comorbidities, size of the uterus on physical examination, the size of the adenomyoma (if present) on pelvic ultrasonography, initial hemoglobin, and hematocrit on admission, whether blood transfusion was required, acute and long-term treatment and whether or not there were any associated VTE and treatment given. Results: Forty-one patients were included in this study. Five (12.2%) out of the 41 patients had associated VTE; all five had pulmonary embolism (PE), while two also had a concurrent left lower limb deep-vein thrombosis. Three out of the five patients had worsening menorrhagia following anticoagulation, which gonadotropin-releasing hormone analogs were effective in controlling. Four of the five patients eventually underwent a hysterectomy for long-term management of adenomyosis. Conclusion: This case series describes a few clinical cases where VTE (particularly PE) has been observed with adenomyosis, the challenges in managing these patients, and effective treatment approaches.

Multiple Cerebral Infarctions Complicating Deep Vein Thrombosis Associated With Uterine Adenomyosis: A Case Report and Literature Review

“…There were a few cases that had co-occurrence of thrombi in other organs: brachiocephalic artery occlusion in one case [4], renal infarction in three cases [4,13,14], and splenic infarction in one case [9]. It has been suggested that adenomyosis can cause coagulopathy [1]. In particular, cerebral infarction caused by coagulopathy due to adenomyosis seems to exhibit similarities to Trousseau's syndrome.…”

“…Uterine adenomyosis, a common disease in which endometrial-like tissue is formed in the myometrium, has been known to cause menstrual pain and menorrhagia, with reports showing a prevalence of approximately 20% among women. Uterine adenomyosis can induce venous thromboembolism in 12.2% of cases [1], during menstruation or hypercoagulation due to tissue factors [2], causing elevated levels of cancer antigen 125 (CA125) [3] associated with menstruation. It has been shown that hypercoagulability associated with uterine adenomyosis can cause cerebral infarction [4], or deep vein thrombosis [1].…”

“…Uterine adenomyosis can induce venous thromboembolism in 12.2% of cases [1], during menstruation or hypercoagulation due to tissue factors [2], causing elevated levels of cancer antigen 125 (CA125) [3] associated with menstruation. It has been shown that hypercoagulability associated with uterine adenomyosis can cause cerebral infarction [4], or deep vein thrombosis [1]. Here, we report on a case of cerebral infarction and review the literature on cases of uterine adenomyosis-associated cerebral infarction.…”

Possible association between adenomyosis and disseminated intravascular coagulation and thromboembolism: A systematic review

“…Hong et al (22) reported 5 patients with adenomyosis who developed pulmonary thromboembolism and/or deep venous thrombosis. However, there were no significant differences in the clinicopathological characteristics between VTE and non-VTE patients; thus, it was unclear whether there was a causal association between adenomyosis and thromboembolism (22).…”

“…Hong et al (22) reported 5 patients with adenomyosis who developed pulmonary thromboembolism and/or deep venous thrombosis. However, there were no significant differences in the clinicopathological characteristics between VTE and non-VTE patients; thus, it was unclear whether there was a causal association between adenomyosis and thromboembolism (22). Some patients with adenomyosis with a history of cerebral infarction or pulmonary thromboembolism have been shown to have elevated levels of plasma TAT, SF, D-dimer and PIC, suggesting an increased predisposition to thromboembolic events (10).…”