Successful conservative treatment for massive uterine bleeding with non-septic disseminated intravascular coagulation after termination of early pregnancy in a woman with huge adenomyosis: case report

Kimura, Fuminori; Takahashi, Akimasa; Kitazawa, Jun; Yoshino, Fumi; Katsura, Daisuke; Amano, Tsukuru; Murakami, Takashi

doi:10.1186/s12905-020-00924-8

Cited by 5 publications

(4 citation statements)

References 26 publications

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“…Among potential agents, nafamostat mesylate (hereafter nafamostat), a serine protease inhibitor, could be one of the promising agents for treating COVID-19. Nafamostat, which provides sufficient prolongation of activated partial thromboplastin time (APTT) without causing major bleeding complications, has been used as an anticoagulant for hemodialysis procedures and disseminated intravascular coagulation (DIC) in Japan and South Korea [12,13]. Previous in vitro studies revealed that nafamostat blocks the entry of SARS-CoV-2 into the human cell by preventing the fusion of the envelope of SARS-CoV-2 with the host cell [14,15].…”

Section: Introductionmentioning

confidence: 99%

Dynamic changes in fibrinogen and D-dimer levels in COVID-19 patients on nafamostat mesylate

Osawa

Okamoto

Ikeda

et al. 2020

J Thromb Thrombolysis

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Critical illnesses associated with coronavirus disease 2019 (COVID-19) are attributable to a hypercoagulable status. There is limited knowledge regarding the dynamic changes in coagulation factors among COVID-19 patients on nafamostat mesylate, a potential therapeutic anticoagulant for COVID-19. First, we retrospectively conducted a cluster analysis based on clinical characteristics on admission to identify latent subgroups among fifteen patients with COVID-19 on nafamostat mesylate at the University of Tokyo Hospital, Japan, between April 6 and May 31, 2020. Next, we delineated the characteristics of all patients as well as COVID-19-patient subgroups and compared dynamic changes in coagulation factors among each subgroup. The subsequent dynamic changes in fibrinogen and D-dimer levels were presented graphically. All COVID-19 patients were classified into three subgroups: clusters A, B, and C, representing low, intermediate, and high risk of poor outcomes, respectively. All patients were alive 30 days from symptom onset. No patient in cluster A required mechanical ventilation; however, all patients in cluster C required mechanical ventilation, and half of them were treated with venovenous extracorporeal membrane oxygenation. All patients in cluster A maintained low D-dimer levels, but some critical patients in clusters B and C showed dynamic changes in fibrinogen and D-dimer levels. Although the potential of nafamostat mesylate needs to be evaluated in randomized clinical trials, admission characteristics of patients with COVID-19 could predict subsequent coagulopathy. Keywords COVID-19 • Anticoagulant • D-dimer • Fibrinogen • Nafamostat mesylate Highlights • All patients with COVID-19 treated on nafamostat mesylate were alive at 30 days from symptom onset. • Using cluster analysis based on clinical characteristics on admission, we identified three subgroups among COVID-19 patients with different clinical presentations of subsequent coagulopathy. • Clinical characteristics on admission are beneficial in predicting subsequent coagulopathy and consider individualized approaches for thromboembolism. • Since COVID-19-associated coagulopathy resembles DIC, a careful evaluation of dynamic changes in coagulopathy, as reflected by fibrinogen and D-dimer levels, is essential.

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Section: Introductionmentioning

confidence: 99%

Dynamic changes in fibrinogen and D-dimer levels in COVID-19 patients on nafamostat mesylate

Osawa

Okamoto

Ikeda

et al. 2020

J Thromb Thrombolysis

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“…5 We also reported a case of uterine adenomyosis with severe hemorrhage due to disseminated intravascular coagulation (DIC) with activated fibrinolysis on day 3 after elective abortion. 7 In this case, coagulation and the fibrinolytic function were activated without a decrease in the blood antithrombin III level, unlike septic DIC. Thus, some uterine adenomyosis may activate the coagulation/fibrinolytic system at the time of withdrawal bleeding or after the termination of pregnancy.…”

Section: Introductionmentioning

confidence: 72%

“…This pathophysiology of adenomyosis is drawing renewed attention. [3][4][5][6][7] We have previously reported that adenomyosis is associated with an increased risk of abnormal coagulation and fibrinolysis in the menstrual period. 5 We also reported a case of uterine adenomyosis with severe hemorrhage due to disseminated intravascular coagulation (DIC) with activated fibrinolysis on day 3 after elective abortion.…”

Section: Introductionmentioning

confidence: 99%

Case of adenomyosis causing the activation of the coagulation system after a complete loss of endometrium following microwave endometrial ablation

Kimura

Hanada

Nakamura

et al. 2021

J of Obstet and Gynaecol

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The formation of microbleed and minute tissue necrosis inside adenomyosis after the shedding of endometrial or endometrial-like tissue within the myometrium during menstruation is receiving attention as a new pathological condition of uterine adenomyosis. These formations might greatly affect coagulation and fibrinolysis function. However, these modulations might occur due to indirect effects of massive hemorrhage from the uterus with adenomyosis. We present a case of adenomyosis in which the patient's coagulation system was markedly activated despite the absence of menstruation due to previous microwave endometrial ablation to prevent massive uterine hemorrhage. Although no uterine bleeding was observed at all, the patient's serum levels of thrombinantithrombin complex and soluble fibrin were abnormally elevated at the time when she complained of lower abdominal pain. As the first such case in the world, the present case is valuable for showing that the coagulation function can be modified by uterine adenomyosis.

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“…Nafamostat is a broad-spectrum serine protease inhibitor possessing significant anti-coagulant and anti-inflammatory effects that help in inhibiting coagulation factor X, coagulation factor XII, prothrombin, Kallikrein-1, Trypsin 1, and ICAM-1 (Kim et al 2016 ). Approved in South Korea and Japan to treat disseminated intravascular coagulation [DIC], pancreatitis and for hemodialysis procedures, nafamostat is a promising agent for the treatment of COVID-19 (Choi and Kang 2015 ; Kimura et al 2020 ). It blocks the entry of SARS-CoV-2 inside the host cell by preventing the fusion of the virus envelope with the human cell (Hoffmann et al 2020c ; Yamamoto and Kiso 2020 ).…”

Section: Potential Covalent Spike Protein Inhibitorsmentioning

confidence: 99%

Therapeutically effective covalent spike protein inhibitors in treatment of SARS-CoV-2

et al. 2021

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COVID-19 [coronavirus disease 2019] has resulted in over 204,644,849 confirmed cases and over 4,323,139 deaths throughout the world as of 12 August 2021, a total of 4,428,168,759 vaccine doses have been administered. The lack of potentially effective drugs against the virus is making the situation worse and dangerous. Numerous forces are working on finding an effective treatment against the virus but it is believed that a de novo drug would take several months even if huge financial support is provided. The only solution left with is drug repurposing that would not only provide effective therapy with the already used clinical drugs, but also save time and cost of the de novo drug discovery. The initiation of the COVID-19 infection starts with the attachment of spike glycoprotein of SARS-CoV-2 to the host receptor. Hence, the inhibition of the binding of the virus to the host membrane and the entry of the viral particle into the host cell are one of the main therapeutic targets. This paper not only summarizes the structure and the mechanism of spike protein, but the main focus is on the potential covalent spike protein inhibitors.

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Successful conservative treatment for massive uterine bleeding with non-septic disseminated intravascular coagulation after termination of early pregnancy in a woman with huge adenomyosis: case report

Cited by 5 publications

References 26 publications

Dynamic changes in fibrinogen and D-dimer levels in COVID-19 patients on nafamostat mesylate

Dynamic changes in fibrinogen and D-dimer levels in COVID-19 patients on nafamostat mesylate

Case of adenomyosis causing the activation of the coagulation system after a complete loss of endometrium following microwave endometrial ablation

Therapeutically effective covalent spike protein inhibitors in treatment of SARS-CoV-2

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