Uterine fibroids and the problem of deep vein thrombosis of the lower extremities. View of a vascular specialist and hematologist

Abstract

The article provides clinical data and an algorithm for the management of patients with symptomatic uterine fibroids complicated by metrorrhagia and venous thrombotic events.Objective: to improve the treatment of patients with uterine fibroids complicated by abnormal menstrual bleeding, anemia and venous thrombotic events due to the implementation of the developed algorithm for diagnosis and treatment.Materials and methods. The study included 15 patients aged 32–49 years with a diagnosis of uterine fibroids with menorrhagia and iron deficiency anemia, complicated by deep vein thrombosis of the lower extremities. Thromboembolism of small branches of the pulmonary artery was diagnosed in 5 (30%) of these patients.The examination algorithm included general clinical tests (general blood and urine analysis, biochemical blood analysis, coagulogram), evaluation of the D-dimer, soluble fibrin monomer complexes, ultrasound of the pelvic organs, ultrasound duplex scanning of the veins of lower extremities, electrocardiography, echocardiography, multispiral computed tomography of chest. All patients underwent endometrial biopsy to exclude oncological pathology.The proposed treatment included: uterine artery embolization to stop bleeding, correction of hemostatic parameters, and anticoagulant therapy of venous thrombotic events after stopping bleeding.Results. Bleeding was stopped in all 100% of patients after endovascular uterine artery embolization. The duration of anticoagulant therapy depended on the causes of venous thrombosis and was at least 3–6 months; it was extended for more than 6 months if there were concomitant risk factors.Conclusions. Uterine artery embolization allows quickly and reliably stopping bleeding and immediately starting adequate anticoagulant therapy for venous thrombotic events.