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Coagulation Status in Women With Endometriosis

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Abstract

Subtle alterations in coagulation and fibrinolysis have been recently reported in patients with endometriosis supporting a potential hypercoagulable status associated with the disease. This cross-sectional study aimed at evaluating some variables of coagulation status and inflammatory markers in women with endometriosis. A total of 314 women who underwent surgery were considered. The case group (n = 169) included patients with a surgical diagnosis of endometriosis, at any stage of disease. The control group (n = 145) included women with a surgical diagnosis of benign gynecologic pathology. No difference was found for thrombin time, International Normalized Ratio (INR), platelet count, neutrophil count, lymphocyte count, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (PLR) between women with endometriosis and controls. Conversely, patients with endometriosis had significantly shortened activated partial thromboplastin time (APTT) when compared to controls (1.08 ± 0.06 and 1.12 ± 0.19, respectively; P <.01). In the subgroup analysis, women with ovarian endometriosis had significantly shortened APTT values in comparison to women without this form and women with stage I to II endometriosis had significantly shorter APTT values and higher PLR than those with stage III to IV disease. In multivariate logistic regression analysis, after controlling for potential confounders, a shortened APTT remained associated with the disease. Activated partial thromboplastin time is shorter in women with endometriosis but still in the normal range. The evidence is insufficient to foresee a possible use of APTT as a diagnostic marker and to claim a crucial role of a systemic hypercoagulable state in the origin of the disease. A role of the local coagulation system in the pathogenesis of the disease cannot be excluded.

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References

  1. Kvaskoff M, Mu F, Terry KL, et al. Endometriosis: a high-risk population for major chronic diseases? Hum Reprod Update. 2015;21(4):500–516.

    PubMed  PubMed Central  Google Scholar 

  2. Zuin M, Rigatelli G, Stellin G, Faggian G, Roncon L. Should women with endometriosis be screened for coronary artery disease? Eur J Intern Med. 2016;35:e19–e20.

    PubMed  Google Scholar 

  3. Lobo RA, Surgical menopause and cardiovascular risks. Menopause. 2007;14(3):562–566.

    PubMed  Google Scholar 

  4. Alhurani RE, Chahal CA, Ahmed AT, Mohamed EA, Miller VM. Sex hormone therapy and progression of cardiovascular disease in menopausal women. Clin Sci (Lond). 2016;130(13):1065–1074.

    CAS  Google Scholar 

  5. Wu Q, Ding D, Liu X, Guo SW. Evidence for a hypercoagulable state in women with ovarian endometriomas. Reprod Sci. 2015;22(9):1107–1114.

    CAS  PubMed  Google Scholar 

  6. Tokmak A, Yildirim G, Oztas, E, et al. Use of neutrophil-to-lymphocyte ratio combined with CA-125 to distinguish endometriomas from other benign ovarian cysts. Reprod Sci. 2016;23(6):795–802.

    CAS  PubMed  Google Scholar 

  7. Yavuzcan A, Caglar M, Ustiin Y, et al. Evaluation of mean platelet volume, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in advanced stage endometriosis with endometrioma. J Turk Ger Gynecol Assoc. 2013;14(4):210–215.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Yang H, Zhu L, Wang S, Lang J, Xu T. Noninvasive diagnosis of moderate to severe endometriosis: the platelet-lymphocyte ratio cannot be a neoadjuvant biomarker for serum cancer antigen 125. J Minim Invasive Gynecol. 2015;22(3):373–377.

    PubMed  Google Scholar 

  9. Lin M, Weng H, Wang X, Zhou B, Yu P, Wang Y. The role of tissue factor and protease-activated receptor 2 in endometriosis. Am J Reprod Immunol. 2012;68(3):251–217.

    CAS  PubMed  Google Scholar 

  10. Osuga Y, Hirota Y, Yoshino O, Hirata T, Koga K, Taketani Y. Proteinase-activated receptors in the endometrium and endometriosis. Front Biosci (Schol Ed). 2012;4:1201–1212.

    Google Scholar 

  11. Cho S, Cho H, Nam A, et al. Neutrophil-to-lymphocyte ratio as an adjunct to CA-125 for the diagnosis of endometriosis. Fertil Steril. 2008;90(6):2073–2079.

    CAS  PubMed  Google Scholar 

  12. Kim SK, Park JY, Jee BC, Suh CS, Kim SH. Association of the neutrophil-to-lymphocyte ratio and CA 125 with the endometriosis score. Clin Exp Reprod Med. 2014;41(4):151–157.

    PubMed  PubMed Central  Google Scholar 

  13. Anderson JA, Weitz JI. Hypercoagulable states. Crit Care Clin. 2011;27(4):933–952.

    PubMed  Google Scholar 

  14. Sanchez AM, Vigano P, Somigliana E, Panina-Bordignon P, Vercellini P, Candiani M. The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Hum Reprod Update. 2014;20(2):217–230.

    CAS  PubMed  Google Scholar 

  15. American Society for Reproductive Medicine 1997. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67(5):817–821.

    Google Scholar 

  16. van Rooijen M, Silveira A, Thomassen S, et al. APC resistance during the normal menstrual cycle. Thromb Haemost. 2007;98(6):1246–1251.

    PubMed  Google Scholar 

  17. Tchaikovski SN, Thomassen MC, Costa SD, Bremme K, Rosing J. Changes in haemostatic parameters during the menstrual cycle and subsequent use of drospirenone-containing oral contraceptives. Thromb Res. 2014;134(5):1032–1037.

    CAS  PubMed  Google Scholar 

  18. Senthil M, Chaudhary P, Smith DD, et al. A shortened activated partial thromboplastin time predicts the risk of catheter-associated venous thrombosis in cancer patients. Thromb Res. 2014;134(1):165–168.

    CAS  PubMed  Google Scholar 

  19. Gentilini D, Perino A, Vigano P, et al. Gene expression profiling of peripheral blood mononuclear cells in endometriosis identifies genes altered in non-gynaecologic chronic inflammatory diseases. Hum Reprod. 2011;26(11):3109–3117.

    CAS  PubMed  Google Scholar 

  20. Leone Roberti Maggiore U, Ferrero S, Mangili G, et al. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update. 2016;22(1):70–103.

    PubMed  Google Scholar 

  21. Sanchez AM, Somigliana E, Vercellini P, Pagliardini L, Candiani M, Vigano P. Endometriosis as a detrimental condition for granulosa cell steroidogenesis and development: from molecular alterations to clinical impact. J Steroid Biochem Mol Biol. 2016;155(ptA):35–46.

    CAS  PubMed  Google Scholar 

  22. Vercellini P, Vigano P, Somigliana E, Fedele L. Endometriosis: pathogenesis and treatment. Nat Rev Endocrinol. 2014;10(5):261–275.

    CAS  PubMed  Google Scholar 

  23. Vigano P, Somigliana E, Panina P, Rabellotti E, Vercellini P, Candiani M. Principles of phenomics in endometriosis. Hum Reprod Update. 2012;18(3):248–259.

    CAS  PubMed  Google Scholar 

  24. Levi M, van der Poll T. Inflammation and coagulation. Crit Care Clin. 2010;38(suppl):S27–S34.

    Google Scholar 

  25. Levi M, van der Poll T, ten Cate H. Tissue factor in infection and severe inflammation. Semin Thromb Hemost. 2006;32(1):33–39.

    CAS  PubMed  Google Scholar 

  26. Sanchez AM, Vigano P, Somigliana E, Cioffi R, Panina-Bordignon P, Candiani M. The endometriotic tissue lining the internal surface of endometrioma: hormonal, genetic, epigenetic status, and gene expression profile. Reprod Sci. 2015;22(4):391–401.

    CAS  PubMed  Google Scholar 

  27. Levi M, Toh CH, Thachil J, Watson HG. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009;145(1):24–33.

    CAS  Google Scholar 

  28. Fujiwara H, Kosaka K, Hamanishi S, et al. Acute elevation of plasma D-dimer levels associated with rupture of an ovarian endometriotic cyst: case report. Hum Reprod. 2003;18(2):338–341.

    CAS  PubMed  Google Scholar 

  29. Kline JA, Runyon MS, Webb WB, Jones AE, Mitchell AM. Prospective study of the diagnostic accuracy of the simplify D-dimer assay for pulmonary embolism in emergency department patients. Chest. 2006;129(6):1417–1423.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Paola Viganò PhD

  2. Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Jessica Ottolina MD, Veronica Sarais MD, Giorgia Rebonato PhD & Massimo Candiani MD

  3. Infertility Unit, Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy

    Edgardo Somigliana MD

Authors
  1. Paola Viganò PhD
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  2. Jessica Ottolina MD
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  3. Veronica Sarais MD
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  4. Giorgia Rebonato PhD
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  5. Edgardo Somigliana MD
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  6. Massimo Candiani MD
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Correspondence to Paola Viganò PhD.

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Viganò, P., Ottolina, J., Sarais, V. et al. Coagulation Status in Women With Endometriosis. Reprod. Sci. 25, 559–565 (2018). https://doi.org/10.1177/1933719117718273

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