Fibrinolysis system in heavy menstrual bleeding in case of recurrent growth of fibromatous nodes

The purpose to study the activity of fibrinolytic reactions in the absent therapeutic effect of correcting heavy menstrual bleeding (HMB) with anti-fibrinolytics with recurrent growth of myomatous nodes. Material and methods. The study is single-center, retrospective, including 366 patients with a history of uterine artery embolization (UAE) for symptomatic uterine fibroids. Depending on the long-term results of the procedure, 2 groups were identified: the observation group (n = 315) — patients with remission for more than 36 months and the main group (n = 51) with recurrent growth of myomatous nodes. At the first, retrospective stage of the research, the clinical and anamnestic characteristics of the comparison groups were studied. At the second, prospective stage, the indicators of the fibrinolysis system were studied: tissue plasminogen activator (t-PA), urokinase plasminogen activator (u-PA) and plasminogen activator inhibitor type 1 (PAI-1) in peripheral blood plasma. Results. In the group of patients with recurrent growth of myomatous nodes after a previous UAE, heavy menstrual bleeding (HMB) was 2.1 times more common (p = 0.0001), while in 77.5% of cases there was no therapeutic effect from the administration of tranexamic acid. In laboratory testing, it was established that in the absence of therapeutic efficacy of the antifibrinolytic, there was an over-threshold t-PA activity (p < 0.0001) and u-PA concentration (p = 0.002). The level of PAI-1 did not depend on the clinical effect. Conclusion. The lack of effect of anti-fibrinolytic therapy of heavy uterine bleeding against the background of the recurrent uterine fibroids is associated with a hyperfibrinolytic shift in the systemic circulation, which suggests the involvement of the fibrinolysis system in the underlying disease pathogenesis and its clinical symptoms in the form of metrorrhagia.