Jiang X L, Yan X, Su H N, Liu Y H, Han R X, Song Z Y, Sun X W, Su D H, Yang X
Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, China.
Department of Obstetrics and Gynecology, Taiyuan Eighth People's Hospital, Taiyuan 030012, China.
Zhonghua Fu Chan Ke Za Zhi. 2023 Apr 25;58(4):286-292. doi: 10.3760/cma.j.cn112141-20221130-00725.
To evaluate different methods' efficacy of controlling acute bleeding and managing long-term menstruation in patients with heavy menstrual bleeding (HMB) associated with antithrombotic therapy. The clinical data of 22 cases with HMB associated with antithrombotic therapy admitted to Peking University People's Hospital from January 2010 to August 2022 were analyzed, aged 39 years old (26-46 years). Changes in menstrual volume, hemoglobin (Hb), and quality of life were collected after control of acute bleeding and long-term menstrual management. Menstrual volume was assessed by pictorial blood assessment chart (PBAC), and quality of life was assessed by menorrhagia multi-attribute scale (MMAS). (1) Treatment of acute bleeding: of the 22 cases with HMB associated with antithrombotic therapy, 16 cases were treated in our hospital and 6 in other hospital for emergency bleeding; of the 16 cases treated in our hospital, 3 underwent emergency intrauterine Foley catheter balloon compression due to severe bleeding (Hb decreased by 20 to 40 g/L within 12 hours). Of the 22 cases with antithrombotic therapy-related HMB, 15 (including 2 cases with severe bleeding) underwent emergency aspiration or endometrial resection, and intraoperative placement of levonorgestrel-releasing intrauterine system (LNG-IUS) followed by a significant reduction in bleeding volume; 3 cases had controlled acute bleeding after rivaroxaban dose reduction and continued observation; 2 cases were given gonadotropin-releasing hormone agonists to control acute bleeding in other hospital, of which 1 case was temporarily treated with periodic blood transfusion, and the other one patient underwent total hysterectomy; and 2 cases had temporary amenorrhea with oral mifepristone after intrauterine balloon compression or oral norethindrone. (2) Long-term menstrual management: of the 22 cases with antithrombotic therapy-related HMB, 15 had LNG-IUS placement and 12 had LNG-IUS placement for 6 months, and menstrual volume was significantly reduced [PBAC scores were 365.0 (272.5-460.0) vs 25.0 (12.5-37.5), respectively; =4.593, <0.001], Hb was significantly increased [91.5 g/L (71.8-108.2 g/L) vs 128.5 g/L (121.2-142.5 g/L); =4.695, <0.001], and quality of life was significantly improved [MMAS scores were 415.0 (327.5-472.5) vs 580.0 (570.0-580.0), respectively; =-3.062, =0.002] before placement compared with 6 months after placement. Three rivaroxaban dose reduction patients' PBAC scores decreased by 20 to 35 but remained >100, and perceived quality of life did not change significantly. Two cases with temporary amenorrhea treated with oral mifepristone felt significantly improved quality of life, and the MMAS scores increased by 220 and 180, respectively. Intrauterine Foley catheter balloon compression, aspiration or endometrial ablation could be used to control acute bleeding in patients with antithrombotic therapy-related HMB, and LNG-IUS for long-term management could reduce menstrual volume, increase hemoglobin, and improve the quality of life of patients.
评估不同方法在控制与抗栓治疗相关的月经过多（HMB）患者急性出血及长期月经管理中的疗效。分析2010年1月至2022年8月北京大学人民医院收治的22例与抗栓治疗相关的HMB患者的临床资料，年龄39岁（26 - 46岁）。收集急性出血控制及长期月经管理后月经血量、血红蛋白（Hb）及生活质量的变化。月经血量通过图像化失血评估图（PBAC）评估，生活质量通过月经过多多属性量表（MMAS）评估。（1）急性出血治疗：22例与抗栓治疗相关的HMB患者中，16例在我院治疗，6例在其他医院治疗紧急出血；在我院治疗的16例中，3例因严重出血（12小时内Hb下降20至40 g/L）接受紧急宫腔 Foley 导尿管球囊压迫。22例与抗栓治疗相关的HMB患者中，15例（包括2例严重出血患者）接受紧急刮宫或子宫内膜切除术，术中放置左炔诺孕酮宫内节育系统（LNG-IUS）后出血量显著减少；3例在利伐沙班减量后急性出血得到控制并继续观察；2例在其他医院给予促性腺激素释放激素激动剂控制急性出血，其中1例临时接受定期输血治疗，另1例接受全子宫切除术；2例在宫腔球囊压迫或口服炔诺酮后口服米非司酮出现暂时闭经。（2）长期月经管理：22例与抗栓治疗相关的HMB患者中，15例放置LNG-IUS，12例放置LNG-IUS 6个月，月经血量显著减少[PBAC评分分别为365.0（272.5 - 460.0）与25.0（12.5 - 37.5）； =4.593，<0.001]，Hb显著升高[91.5 g/L（71.8 - 108.2 g/L）与128.5 g/L（121.2 - 142.5 g/L）； =4.695，<0.001]，与放置前相比，放置6个月后生活质量显著改善[MMAS评分分别为415.0（327.5 - 472.5）与580.0（570.0 - 580.0）； = - 3.062， =0.002]。3例利伐沙班减量患者的PBAC评分下降20至35，但仍>100，生活质量感知无显著变化。2例口服米非司酮出现暂时闭经的患者生活质量明显改善，MMAS评分分别增加220和180。宫腔Foley导尿管球囊压迫、刮宫或子宫内膜消融可用于控制与抗栓治疗相关的HMB患者的急性出血，LNG-IUS用于长期管理可减少月经血量、增加血红蛋白并改善患者生活质量。
