External genital endometriosis post-surgery hemostasis parameters

Introduction. Endometriosis is one of the common diseases with poorly elucidated underlying nature and pathogenetic mechanisms. Clinical trials suggest that women suffering from it have hemostasis disorders. However, the severity of relevant changes and their origin remain debated. Aim: to study the dynamics of hemostasis system parameters in patients underwent surgical treatment of external genital endometriosis (EGE). Materials and Methods. A total of 120 women were enrolled into the prospective interventional comparative controlled study: 40 patients with EGE scheduled for surgical treatment (main group), 40 patients with other benign gynecological diseases requiring surgical intervention (comparison group), and 40 apparently healthy women (control group). Нemostasis system status was assessed based on the results of 3 visits during 3 month-follow-up by assessing the following biomarkers: metalloproteinase ADAMTS-13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13), von Willebrand factor (vWF), D-dimer, protein C, antithrombin III (AT-III), activated partial thromboplastin time (APTT) and Рarus-test values. Results. Prior to surgery, among EGE women a subclinical but significant increase in procoagulant biomarkers was observed compared to other groups: vWF – 1.24 [1.17–1.35] U/ml, D-dimer – 173.5 [73.5–221.23] ng/ml. Evaluation of the remaining parameters showed no clinical significance of the observed changes. The endometriosis-related surgical intervention was accompanied by increase in specific procoagulant factors a week post-treatment apparently associated with surgical manipulations. However, 3 months later, hemostasis system status partially normalized as revealed by lower biomarkers examined, which in some cases were significantly decreased compared to those observed before surgery. At the same time, differences between the study groups remained statistically significant. Conclusion. Patients with EGE were noted to have a subclinical risk of thrombogenesis. Upon this, surgical treatment and rehabilitation during recovery period allowed to improve overall state of the hemostasis system, thereby reducing a thrombogenesis risk.