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Pelvic Adhesion and Gonadotropin-Releasing Hormone Analogue: Effects of Triptorelin Acetate Depot on Coagulation and Fibrinolytic Activities

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Abstract

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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References

  1. 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.

    Article  PubMed  CAS  Google Scholar 

  2. Menzies D. Peritoneal adhesions. Incidence, cause, and prevention. Surg Ann. 1992;24(pt 1):27–45.

    Google Scholar 

  3. 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.

    Article  PubMed  CAS  Google Scholar 

  4. Bronson RA, Wallace EE. Lysis of periadnexal adhesions for correction of infertility. Fertil Steril. 1977;28(6):613–619.

    Article  PubMed  CAS  Google Scholar 

  5. Davey AK, Maher PJ. Surgical adhesions: a timely update, a great challenge for the future. J Minim Invasive Surg. 2007;14(1): 15–22.

    Google Scholar 

  6. 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.

    Article  PubMed  CAS  Google Scholar 

  7. Holmdahl L. The role of fibrinolysis in adhesion formation. Eur J Surg. 1997;577(suppl):24–31.

    Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  PubMed  CAS  Google Scholar 

  10. Vipond MN, Whawell SA, Thompson JN, Dudley HAF. Peritoneal fibrinolityc activity and intra-abdominal adhesion. Lancet. 1990;335(8698):1120–1122.

    Article  PubMed  CAS  Google Scholar 

  11. Holtz G. Current use of ancillary modalities for adhesion prevention. Fertil Steril. 1985;44(2):174–176.

    Article  PubMed  CAS  Google Scholar 

  12. 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.

    PubMed  CAS  Google Scholar 

  13. 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.

    Article  PubMed  CAS  Google Scholar 

  14. 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.

    Article  CAS  Google Scholar 

  15. Schindler AE. Gonadotropin-releasing hormone agonists for prevention of postoperative adhesions: an overview. Gynecol Endocrinol. 2004;19(1):51–55.

    Article  PubMed  CAS  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Adamson GD. Myomectomy, GnRH analogs and adhesions. Prog Clin Biol Res. 1993;381:155–185.

    PubMed  CAS  Google Scholar 

  18. 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.

    Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  CAS  Google Scholar 

  21. 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.

    Article  PubMed  CAS  Google Scholar 

  22. 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.

    Article  PubMed  CAS  Google Scholar 

  23. 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.

    Article  CAS  Google Scholar 

  24. 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.

    Article  PubMed  CAS  Google Scholar 

  25. 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.

    PubMed  CAS  Google Scholar 

  26. Kohler HP, Grant PJ. Plasminogen-activator inhibitor type 1 and coronary artery disease. N Engl J Med. 2000;342(24): 1792–1801.

    Article  PubMed  CAS  Google Scholar 

  27. 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.

    Article  CAS  Google Scholar 

  28. 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.

    Article  PubMed  CAS  Google Scholar 

  29. Scott-Coombes D, Whawell S, Vipond MN, Thompson J. Human intraperitoneal fibrinolitic response to elective surgery. Br J Surg. 1995;82(3):414–417.

    Article  PubMed  CAS  Google Scholar 

  30. 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.

    PubMed  Google Scholar 

  31. Bajzar L. Thrombin activatable fibrinolysis inhibitor and an anti-fibrinolytic pathway. Arterioscler Thromb Vasc Biol. 2000; 20(12):2511–2518.

    Article  PubMed  CAS  Google Scholar 

  32. 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.

    Article  PubMed  CAS  Google Scholar 

  33. Esmon CT. Protein C anticoagulant pathway and its role in controlling microvascular thrombosis and inflammation. Crit Care Med. 2001;29(7 suppl): S48–S52.

    Article  PubMed  CAS  Google Scholar 

  34. 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.

    Article  PubMed  CAS  Google Scholar 

  35. Mannucci P, Tripodi A. Laboratory screening of inherited thrombotic syndromes. Thromb Haemos. 1987;57(3):247–251.

    Article  CAS  Google Scholar 

  36. 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.

    Article  PubMed  CAS  Google Scholar 

  37. 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.

    Article  CAS  Google Scholar 

  38. 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.

    Article  CAS  Google Scholar 

  39. Preston FE, Burakiwski BK, Porter NR, Malia RG. The fibrinolytic response to stanazol in normal subjects. Throm Res. 1981;22(5–6):543–552.

    Article  CAS  Google Scholar 

  40. Rennie JAN, Bewsher PD, Murchison LE, Ogston D. Coagulation and fibrinolysis in thyroid disease. Acta Haematologica. 1978; 59(3):171–177.

    Article  PubMed  CAS  Google Scholar 

  41. 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.

    Article  PubMed  CAS  Google Scholar 

  42. 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.

    Article  PubMed  CAS  Google Scholar 

  43. 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.

    Article  PubMed  CAS  Google Scholar 

  44. 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.

    Article  PubMed  CAS  Google Scholar 

  45. Kamel RM. Prevention of postoperative peritoneal adhesions. Eur J Obstet Gynecol Reprod Biol. 2010;150(2):111–118.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrical-Gynecological and Urological Science and Reproductive Medicine, Federico II University, via S. Pansini 5, 80131, Naples, Italy

    Maria Antonietta Di Nardo MD, Maria Laura Annunziata MD, Marianna De Falco MD, PhD & Andrea Di Lieto MD, PhD

  2. Laboratory of Haemostasis, Department of Biochemistry and Medical Biotechnology, Federico II University, Naples, Italy

    Massimiliano Ammirabile MD

  3. Department of Clinical and Experimental Medicine, Regional Reference Centre for Coagulation Disorders, Federico II University, Naples, Italy

    Matteo Nicola Dario Di Minno MD & Anna Lilia Ruocco MD

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  1. Maria Antonietta Di Nardo MD
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  2. Maria Laura Annunziata MD
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  7. Andrea Di Lieto MD, PhD
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Correspondence to Maria Antonietta Di Nardo MD.

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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

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