The study investigated the impact of gonadotropin-releasing hormone analogue (GnRH-a) on coagulation and fibrinolytic activities and its effectiveness in the prevention of pelvic adhesion after myomectomy. Thirty-two infertile women underwent myomectomy followed by adhesion evaluation surgery with a second-look laparoscopy. Before myomectomy, 15 women were treated with triptorelin acetate for 3 months and 17 received no treatment. Plasminogen activator inhibitor (PAI), thrombin activatable fibrinolysis inhibitor (TAFI), protein C (PC), plasminogen, α2-antiplasmin were determined by enzyme-linked immunosorbent assays and the activity of coagulation factors V and VIII by coagulometric methods. Patients treated with GnRH-a showed significant decrease in PAI, TAFI, factors V, and VIII (P < .05) and increased PC (P < .05), but no significant change in plasminogen and α2-antiplasmin levels compared with control group. The incidence, extent, and severity of adhesions were significantly lower in GnRH-a-treated patients compared with control group (P < .05), suggesting a possible critical role of the GnRH-a therapy in preventing postoperative adhesion development.
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Monk BJ, Berman ML, Montz FJ. Adhesions after extensive gynecologic surgery: clinical significance, etiology and prevention. Am J Obstet Gynecol. 1994;170(5 pt 1):1396–1403.
Menzies D. Peritoneal adhesions. Incidence, cause, and prevention. Surg Ann. 1992;24(pt 1):27–45.
Trimbos-Kemper TCM, Trimbos JB, van Hall EV. Adhesion formation in tubal surgery: results of the eight day laparoscopy in 188 patients. Fertil Steril. 1985;43(3):395–400.
Bronson RA, Wallace EE. Lysis of periadnexal adhesions for correction of infertility. Fertil Steril. 1977;28(6):613–619.
Davey AK, Maher PJ. Surgical adhesions: a timely update, a great challenge for the future. J Minim Invasive Surg. 2007;14(1): 15–22.
Tulandi I, Collins JA, Burrows E, et al. Treatment-dependent and treatment-indipendent pregnancy among women with periadnexal adhesions. Am J Obstet Gynecol. 1990;162(2):354–357.
Holmdahl L. The role of fibrinolysis in adhesion formation. Eur J Surg. 1997;577(suppl):24–31.
diZerega GS, Campeau JD. Peritoneal repair and post-surgical adhesion formation. Biochemical events in peritoneal tissue repair. Hum Reprod Update. 2001;7(6):547–555.
Hellebrekers BW, Trimbos-Kemper TC, Boesten L, et al. Preoperative predictors of postsurgical adhesion formation and the Prevention of Adhesions with Plasminogen Activator (PAPA-study): results of a clinical pilot study. Fertil Steril. 2009;91(4):1204–1214.
Vipond MN, Whawell SA, Thompson JN, Dudley HAF. Peritoneal fibrinolityc activity and intra-abdominal adhesion. Lancet. 1990;335(8698):1120–1122.
Holtz G. Current use of ancillary modalities for adhesion prevention. Fertil Steril. 1985;44(2):174–176.
Luciano AA, Maier DB, Nulsen JC, Whitman GF, Koch EI. A comparative study of postoperative adhesion formation following laser surgery by laparoscopy versus laparotomy in the rabbit model. Obstet Gynecol. 1989;74(2):220–224.
Wright JA, Sharpe-Timms KL. Gonadotropin-releasing hormone agonist therapy reduces postoperative adhesion formation and reformation after adhesiolysis in rat models for adhesion formation and endometriosis. Fertil Steril. 1995;63(5):1094–1100.
Imai A, Sugiyama M, Furui T, Takahashi S, Tamaya T. Gonadotropin-releasing hormones agonist therapy increases peritoneal fibrinolytic activity and prevents adhesion formation after myomectomy. J Obstet Gynecol. 2003;23(6):660–663.
Schindler AE. Gonadotropin-releasing hormone agonists for prevention of postoperative adhesions: an overview. Gynecol Endocrinol. 2004;19(1):51–55.
Coddington CC, Grow DR, Ahmed MS, Toner JP, Cook E, Diamond MP. Gonadotropin-releasing hormone agonist pretreatment did not decrease postoperative adhesion formation after abdominal myomectomy in a randomized control trial. Fertil Steril. 2009;91(5):1909–1913.
Adamson GD. Myomectomy, GnRH analogs and adhesions. Prog Clin Biol Res. 1993;381:155–185.
Lethaby A, Vollenhoven B, Sowter M. Preoperative GnRH-analogue therapy before hysterectomy or myomectomy for uterine fibroids. (Cochrane Review). In: The Cochrane Library. Oxford: Update Software; 2001.
Di Lieto A, De Falco M, Staibano S, et al. Effects of gonadotropin-releasing hormone agonist on uterine volume and vasculature and on the immunhistochemical expression of basic fibroblast growth factor (bFGF) in uterine leiomyomas. Int J Gynecol Pathol. 2003;22(4):353–358.
Canbaz MA, Ustu¨n C, Kocak I, Yanik FF. The comparison of gonadotrophin-releasing hormone agonist therapy and intraperitoneal Ringer’s lactate solution in prevention of postoperative adhesion formation in rat models. Eur J Obstet Gynecol Reprod Biol. 1999;82(2):219–222.
Grow DR, Coddington CC, Hsiu JG, Mikich Y, Hodgen GD. Role of hypoestrogenism on sex steroid antagonist in adhesion formation after myometrial surgery in primates. Fertil Steril. 1996; 66(1):140–147.
Word RA, Odom MJ, Byrd W, Carr BR. The effect of gonadotropin-releasing hormone agonists on growth hormone secretion in adult premenopausal women. Fertil Steril. 1990; 54(1):73–78.
Di Lieto A, De Falco M, Pollio F, et al. Clinical response, vascular change, and angiogenesis in gonadotropin-releasing hormone analogue-treated women with uterine myomas. J Soc Gynecol Inv. 2005;12(2):123–128.
Aleem FA, Predanic M. The hemodynamic effect of GnRH agonist therapy on uterine leiomyoma vascularity: a prospective study using transvaginal color Doppler sonography. Gynecol Endocrinol. 1995;9(3):253–258.
Ferrero S, Gillott DJ, Remorgida V, Anserini P, Ragni N, Grudzinskas JG. GnRH analogue remarkably down-regulates inflammatory proteins in peritoneal fluid proteome of women with endometriosis. J Reprod Med. 2009;54(4):223–231.
Kohler HP, Grant PJ. Plasminogen-activator inhibitor type 1 and coronary artery disease. N Engl J Med. 2000;342(24): 1792–1801.
Di Minno MN, Pezzullo S, Palmieri V, et al. Protein C and protein S changes in GH-deficient adults on r-HGH replacement therapy: correlations with PAI-1 and t-PA plasma levels. Thromb Res. 2010;126(6):434–438.
Ivarsson ML, Bergstrom M, Eriksson E, Risberg B, Holmdahl L. Tissue markers as predictors of postoperative adhesions. Br J Surg. 1998;85(11):1549–1554.
Scott-Coombes D, Whawell S, Vipond MN, Thompson J. Human intraperitoneal fibrinolitic response to elective surgery. Br J Surg. 1995;82(3):414–417.
Winkler U, Buhler K, Koslowski S, Oberhoff C, Schindler AE. Plasmatic haemostatsis in gonadotropin-releasing hormone analogues therapy: effects of leuprolide acetate depot on coagulatory and fibrinolytic activities. Clin Ther. 1992;14(suppl A): 114–119.
Bajzar L. Thrombin activatable fibrinolysis inhibitor and an anti-fibrinolytic pathway. Arterioscler Thromb Vasc Biol. 2000; 20(12):2511–2518.
Urano T, Castellino FJ, Ihara H, Suzuki Y, Ohta M, Suzuki K, Mogami H. Activated protein C attenuates coagulation-associated over-expression of fibrinolytic activity by suppressing the thrombin-dependent inactivation of PAI-1. J Thromb Haemost. 2003;1(12):2615–20.
Esmon CT. Protein C anticoagulant pathway and its role in controlling microvascular thrombosis and inflammation. Crit Care Med. 2001;29(7 suppl): S48–S52.
Bell H, Odegaard OR, Andersson T, Raknerud N. Protein C in patients with alcoholic cirrhosis and other liver diseases. J Hepatol. 1992;14(2–3):163–177.
Mannucci P, Tripodi A. Laboratory screening of inherited thrombotic syndromes. Thromb Haemos. 1987;57(3):247–251.
Hellgren M, Blombäck M. Studies on blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium. Gynecol Obstet Invest. 1981;12(3):141–154.
Tait RC, Walker ID, Conkie JA, et al. Plasminogen levels in healthy volunteers. Influence of age, sex, smoking and oral contraceptives. Thromb Haem. 1992;68(5):506–510.
Grace CS, Goldrick RB. Fibrinolysis and body build. Interrelationships between blood fibrinolysis, body composition and parameters of lipid and carbohydrate metabolism. J Atherosclerosis Res. 1968;8(4):705–719.
Preston FE, Burakiwski BK, Porter NR, Malia RG. The fibrinolytic response to stanazol in normal subjects. Throm Res. 1981;22(5–6):543–552.
Rennie JAN, Bewsher PD, Murchison LE, Ogston D. Coagulation and fibrinolysis in thyroid disease. Acta Haematologica. 1978; 59(3):171–177.
Schrader J, Gallimore MJ, Eisenhauer T, et al. Parameters of the Kallikrein-kinin, coagulation and fibrinolytic system as early indicators of kidney transplant rejection. Nephron. 1988;48(3): 183–189.
Sazonova IY, Thomas BM, Gladysheva IP, Houng AK, Reed GL. Fibrinolysis is amplified by converting α2-antiplasmin from a plasmin inhibitor to a substrate. J Thromb Haemost. 2007;5(10): 2087–2094.
Bakkum EA, van Blitterswiijk CA, Emeis JJ, Trimbos JB, Dalmeijer RAJ, Trimbos-Kemper TCM. Long-term analysis of peritoneal plasminogen activator activity and adhesion formation after surgical trauma in the rat model. Fertil Steril. 1996; 66(6):1018–1022.
Sharpe-Timms KL, Zimmer RL, Jolliff WJ, Wright JA, Nothnick WB, Curry TE. Gonadotropin-releasing hormone agonist (GnRH-a) therapy alters activity of plasmonogen activators, matrix metalloproteinases, and their inhibitors in rat models for adhesion formation and endometriosis: potential GnRH-a-regulated mechanisms reducing adhesion formation. Fertil Steril. 1998;69(5):916–923.
Kamel RM. Prevention of postoperative peritoneal adhesions. Eur J Obstet Gynecol Reprod Biol. 2010;150(2):111–118.
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Di Nardo, M.A., Annunziata, M.L., Ammirabile, M. et al. Pelvic Adhesion and Gonadotropin-Releasing Hormone Analogue: Effects of Triptorelin Acetate Depot on Coagulation and Fibrinolytic Activities. Reprod. Sci. 19, 615–622 (2012). https://doi.org/10.1177/1933719111428517
- coagulation system
- gonadotropin-releasing hormone analogue
- fibrinolytic system
- pelvic adhesion