Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada; CancerCare Manitoba, Winnipeg, MB, Canada; Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada.
Haemophilia. 2013 Nov;19(6):933-8. doi: 10.1111/hae.12184. Epub 2013 May 28.
The levonorgestrel-releasing intrauterine system (LNG-IUS) is indicated for the management of menorrhagia and for contraception. The LNG-IUS is effective at reducing menstrual bleeding and improving haemoglobin among women with bleeding disorders. Expulsion rates for the LNG-IUS among normal women are reported to be approximately 5-10%. The aim of this study was to examine the malposition and expulsion rates of the LNG-IUS among women with inherited bleeding disorders. We conducted a retrospective study of women with an inherited bleeding disorder in Kingston, Canada treated with an LNG-IUS between May 2005 and June 2012. The primary outcome was a combined endpoint of expulsion and/or malposition. Predetermined secondary outcomes were patient satisfaction and changes in haemoglobin and ferritin levels. The median age of the women at the time of LNG-IUS insertion was 31 years (range 18-43, mean 32.1 years). The most common diagnosis was type 1 VWD (12/20, 60%). There were three LNG-IUS expulsions and two episodes of device malposition resulting in removal [5/20 (25.0%), 95% CI 11.2-46.9%]. An additional five women had their device removed prematurely. The overall proportion of devices resulting in discontinuation in this population was 10/20 (50.0%, 95% CI 29.9-70.1%). In this retrospective study, a significant proportion of women with an inherited bleeding disorder had an LGN-IUS removed due to poor patient satisfaction, malposition, or expulsion. Further studies into the causes of higher complication rates and interventions such as premedication or prolonged treatment with antifibrinolytic agents targeted at improving outcomes in this population are required.
左炔诺孕酮宫内释放系统（LNG-IUS）用于治疗月经过多和避孕。LNG-IUS 可有效减少出血性疾病妇女的月经出血并提高血红蛋白水平。在正常女性中，LNG-IUS 的排出率约为 5-10%。本研究旨在检查遗传性出血性疾病女性中 LNG-IUS 的错位和排出率。我们对加拿大金斯顿的患有遗传性出血性疾病并在 2005 年 5 月至 2012 年 6 月期间接受 LNG-IUS 治疗的女性进行了回顾性研究。主要结局是排出和/或错位的联合终点。预定的次要结局是患者满意度以及血红蛋白和铁蛋白水平的变化。LNG-IUS 插入时女性的中位年龄为 31 岁（范围 18-43 岁，平均 32.1 岁）。最常见的诊断是 1 型 VWD（12/20，60%）。有 3 例 LNG-IUS 排出和 2 例装置错位导致取出[5/20（25.0%），95%CI 11.2-46.9%]。另外 5 名女性提前取出了她们的装置。在该人群中，因患者不满意、错位或排出而导致装置停止使用的比例为 10/20（50.0%，95%CI 29.9-70.1%）。在这项回顾性研究中，由于患者满意度低、错位或排出，很大一部分遗传性出血性疾病女性的 LGN-IUS 被取出。需要进一步研究导致更高并发症率的原因，并采取干预措施，如预先用药或延长抗纤维蛋白溶解药物治疗，以改善该人群的结局。
