FIBRINOLYTIC ACTIVITY <i>IN UTERO</i> AND BLEEDING COMPLICATIONS WITH INTRAUTERINE CONTRACEPTIVE DEVICES

Bonnar, J.; Kasonde, K.; Haddon, M.E.; Hassanein, M; Allington, M. J.

doi:10.1111/j.1471-0528.1976.tb00800.x

Cited by 26 publications

(14 citation statements)

References 9 publications

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“…This bleeding may be attributed to the trauma caused by the device increasing the plasminogen activator and free plasmin activity. This con- firms the report of Bonnar et al (4), who reported increased area of lysis in vitro caused by loops which were removed from women with menorrhagia.…”

Section: Women Wearing Lippes Loops and Cu-t(200)ssupporting

confidence: 85%

Fibrinolytic Activity of Menstrual Blood in Normal and Menorrhagic Women and in Women Wearing the Lippes Loop and the Cu‐T(200)

Hefnawi

Kandil

et al. 1979

Intl J Gynecology & Obste

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Assessment was made of the fibrinolytic activity in menstrual and peripheral blood of 30 normally menstruating and 30 menorrhagic patients and of 30 women wearing Lippes Loops and 15 wearing CU-T (200)s. Assessment was performed by measuring the area of lysis on heated and unheated fibrin plates. Also, histochemical identification of fibrin fibrils in the menstrual endometrium was performed by Mallory's phosphotungstic acid hematoxylin method. Results in the normally menstruating group were compared to those of the menorrhagic women, and together these were compared with results in the groups of women wearing intrauterine devices. The fibrinolytic activity in menstrual blood was significantly increased in menorrhagic patients compared to that in normally menstruating patients, but no significant difference was detected in the plasma of either group. The histochemical study of the normally menstruating endometrium revealed dense intravascular and extravascular deposits of fibrin. Less dense intravascular fibrin deposits, but no extravascular ones, were present in the menorrhagic patients. The increase in the fibrinolytic activity of menstrual blood and the decrease in the density of fibrin deposits in the menstrual endometrium of the menorrhagic women were thus associated and were probably involved in the excessive menstrual loss. The fibrinolytic activity of menstrual blood in women wearing Lippes Loops was higher than that in women with Cu-T (200)s and was associated with decreased density of fibrin fibrils in the menstruating endometrium. This may explain the increased blood loss associated with the use of the Lippes Loop.

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Section: Women Wearing Lippes Loops and Cu-t(200)ssupporting

confidence: 85%

Fibrinolytic Activity of Menstrual Blood in Normal and Menorrhagic Women and in Women Wearing the Lippes Loop and the Cu‐T(200)

Hefnawi

Kandil

et al. 1979

Intl J Gynecology & Obste

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“…Large numbers of macrophages or monocytes adhere to IUCDs, and higher cell counts were seen in menorrhagia and intermenstrual bleeding associated with significant fibrinolytic activity surrounding the device [17,18,33]. However, no increase was seen in association with the use of progesterone‐releasing device [19].…”

Section: Discussionmentioning

confidence: 99%

“…They are influenced by the cyclic variation of the sex hormone concentration at different phases of the menstrual cycle. Increased numbers of monocytes or macrophages known to adhere to intrauterine contraceptive devices (IUCDs) are associated with increased fibrinolytic activity in the endometrium [17,18], whereas no increase was seen on progesterone‐releasing devices [19]. In dysfunctional uterine bleeding (DUB), increased fibrinolytic activity was observed in the menstrual fluid and is suggested to be a major contributing factor in the etiology of menorrhagia [20].…”

Section: Introductionmentioning

confidence: 99%

The effect of levonorgestrel‐releasing intrauterine system use on menstrual blood loss and the hemostatic, fibrinolytic/inhibitor systems in women with menorrhagia

Koh

Singh

2007

Journal of Thrombosis and Haemostasis

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To cite this article: Koh SCL, Singh K. The effect of levonorgestrel-releasing intrauterine system use on menstrual blood loss and the hemostatic, fibrinolytic/inhibitor systems in women with menorrhagia. J Thromb Haemost 2007; 5: 133-8.Summary. Background: Menorrhagia is known to be associated with uterine fibroids, adenomyosis, pelvic infections, endometrial polyps and clotting defects. A viable alternative therapy to hysterectomy should alleviate heavy menstrual blood flow and consequently improve the quality-of-life measures in women presenting with menorrhagia. The levonorgestrelreleasing intrauterine system (LNG-IUS) ranks higher than medical treatments in terms of efficacy, comparable improvements in quality of life and psychological well-being. Objective: The purpose of the study was to determine the effects of 6 months of LNG-IUS use on menstrual blood loss and the hemostatic, fibrinolytic/inhibitor systems in blood and the endometrium in women with menorrhagia with known pathologic causes. Patients and methods: Samples from 41 women were analyzed. Hemoglobin, hematocrit, thrombelastography, tissue-type plasminogen activator (t-PA), urokinase plasminogen activator (u-PA), u-PA receptor (u-PAR), plasminogen activator inhibitor-1/2 (PAI-1/2), D-dimer and von Willebrand factor (VWF) were determined, and t-PA, u-PA and PAI-1/2 were also determined in endometrial tissue extracts. Results: Menorrhagia was reduced in 89% of women by 3 months; by 6 months all women had no menorrhagia, and 39% of women had become amenorrhoeic. Hemoglobin and hematocrit levels showed improvement, and reached normal reference levels by 6 months. There were no systemic changes in the fibrinolytic/ inhibitor systems and VWF, except for a decreased u-PAR level. However, in the endometrium, significant elevations in PAI-1/2 together with u-PAR levels were seen at 6 months. Conclusions: The slow levonorgestrel-release intrauterine device use results in high expression of fibrinolytic inhibitors (PAI-1/2) and upregulated u-PAR expression in the endometrium. Systemic hemostasis was not significantly altered. The study demonstrated that LNG-IUS is highly effective in the treatment of menorrhagia with known pathologic causes.

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“…These observations imply that the local differences in FA reported previously after application of plast and copper IUDs probably reflect a foreign body reaction [8,9]. However, the sutured tiny incision had no effect on the FA of the uterine segment with the scar, neither did such a mild surgical trauma influence the FA in the other segments of the uterine horn.…”

Section: Discussionmentioning

confidence: 91%

Decreased fibrinolytic activity in the rat uterus after laparotomy

1985

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The influence of different intrauterine devices (IUDs) on the uterine fibrinolysis has been extensively studied in rodents with two uterine horns. In this experimental model an IUD is inserted into one horn by a surgical procedure including laparotomy and uterotomy. The effect of these two surgical steps on the fibrinolysis in the endometrium determined according to Todd's histochemical fibrin slide technique was studied in the present series comprising 26 rats. The fibrinolytic activity (FA) in the rat uterus was independent of the biopsy site in the uterine horns. However, significant depression of endometrial fibrinolysis was demonstrated 2 weeks after laparotomy, whereas no effect of a tiny incision in the uterine wall was recorded. In conclusion, a sham operation of the control horn in rodent studies on the fibrinolytic effect of IUDs according to this experimental model is not necessary.

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FIBRINOLYTIC ACTIVITY IN UTERO AND BLEEDING COMPLICATIONS WITH INTRAUTERINE CONTRACEPTIVE DEVICES

Cited by 26 publications

References 9 publications

Fibrinolytic Activity of Menstrual Blood in Normal and Menorrhagic Women and in Women Wearing the Lippes Loop and the Cu‐T(200)

Fibrinolytic Activity of Menstrual Blood in Normal and Menorrhagic Women and in Women Wearing the Lippes Loop and the Cu‐T(200)

The effect of levonorgestrel‐releasing intrauterine system use on menstrual blood loss and the hemostatic, fibrinolytic/inhibitor systems in women with menorrhagia

Decreased fibrinolytic activity in the rat uterus after laparotomy

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