Аномальные маточные кровотечения. Гемостатическая терапия: взгляд гематолога

Виноградова М.А. Аномальные маточные кровотечения. Гемостатическая терапия: взгляд гематолога. Гинекология. 2022;24(2):157–162. DOI: 10.26442/20795696.2022.2.201483

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Vinogradova MA. Abnormal uterine bleeding. Hemostatic therapy: hematologist point of view. Gynecology. 2022;24(2):157–162. DOI: 10.26442/20795696.2022.2.201483

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Аннотация

Аномальные маточные кровотечения (АМК) – распространенная патология на стыке специальностей, преимущественно встречающаяся у женщин репродуктивного возраста. Выделяют 2 основные группы их причин: структурная патология женской репродуктивной системы и функциональные изменения, к которым относится в том числе патология системы гемостаза. Независимо от выраженности проявлений, для эффективности лечения важно установить достоверную причину АМК и выбрать прецизионную терапевтическую стратегию. Однако существуют универсальные терапевтические подходы, позволяющие обеспечить гемостатический эффект вне зависимости от этиологии процесса. Ингибиторы фибринолиза, в частности транексамовая кислота, – основа данного подхода.

Ключевые слова: аномальные маточные кровотечения, обильные менструальные кровотечения, женщины репродуктивного возраста, кровотечения в пременопаузе, транексамовая кислота, ингибиторы фибринолиза

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Abnormal uterine bleeding (AUB) is a common pathology at the confluence of different specialties, mainly occurring in women of reproductive age. There are two main groups of AUB causes: the structural pathology of the female reproductive system and the functional changes, which include the pathology of the hemostatic system, among other things. Regardless of the severity of manifestations, for the efficacy of the treatment, it is important to establish the certain cause of AUB and to choose the precision therapeutic strategy. However, there are universal therapeutic approaches to provide the hemostatic effect, regardless of the etiology of the process. Fibrinolysis inhibitors, in particular, tranexamic acid, are the basis of this approach.

Keywords: abnormal uterine bleeding, heavy menstrual bleeding, women of reproductive age, perimenopause bleeding, tranexamic acid, fibrinolysis inhibitors

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Список литературы

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22. Mannucci PM. Hemostatic drugs. NEJM. 1998;339:245-53.
23. Thorne JG, James PD, Reid RL. Heavy menstrual bleeding: is tranexamic acid a safe adjunct to combined hormonal contraception? Contraception. 2018;98(1):1-3. DOI:10.1016/j.contraception.2018.02.008
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27. La S, Warner GT, Cope E. Treatment of menorrhagia with tranexamic acid. a double-blind trial summary: a double-blind trial. Br Med J.1970;4:214-6.
28. Reid RL, Westhoff C, Mansour D, et al. Oral contraceptives and ve- nous thromboembolism: consensus opinion from an international workshop held in Berlin, Germany in December 2009. J Fam Plan Reprod Heal Care. 2010;36:117-22.
29. Lethaby A, Farquhar C, Hickey M. Antifibrinolytics for heavy menstrual bleeding (Review). Cochrane Database Syst Rev. 2018;1-76.
30. Ker K, Roberts I, Chaudhri R, et al. Tranexamic acid for the pre- vention of postpartum bleeding in women with anaemia: study protocol for an international, randomised, double-blind, placebo- controlled trial. Trials. 2018;19:1-19.
31. Nichols WL, Hultin MB, James AH, et al. Von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA). Haemophilia. 2008;14(2):171-232.
32. Bradley LD, Gueye N-A. The medical treatment of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol. 2016;214(1):31-44.
33. Connell NT, Flood VH, Brignardello-Petersen R, et al. ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease. Blood Adv. 2021;5:301-25.
34. Lin H, Xu L, Yu S, et al. Therapeutics targeting the fibrinolytic system. Exp Mol Med. 2020;52:367-79.

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1. Karlsson TS, Marions LB, Edlund MG. Heavy menstrual bleeding significantly affects quality of life. Acta Obstet Gynecol Scand. 2014;(93):52-7.
2. Lukes AS, Baker J, Eder S, Adomako TL. Daily menstrual blood loss and quality of life in women with heavy menstrual bleeding. Womens Health. 2012;8(5):503-11.
3. Matteson KA, Baker CA, Clark MA, Frick KD. Abnormal uterine bleeding, health status, and usual source of medical care: analyses using the Medical Expenditures Panel Survey. J Womens Health (Larchmt). 2013;22:959-65.
4. Munro MG, Critchley HO, Broder MS, Fraser IS; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM- COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13. DOI:10.1016/j.ijgo.2010.11.011
5. Lethaby A, Duckitt K, Farquhar C. Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013:000400.
6. NICE Clinical Guideline «Heavy menstrual bleeding», 2007, updated 2018, 2020. Available at: https://nice.org.uk.guidance/ng88 Accessed: 14.03.2022.
7. Rossiiskoe obshchestvo akusherov-ginekologov. Klinicheskie rekomendatsii Minzdrava Rossii “Anomal'nye matochnye krovotecheniia”, 2021. Available at:
https://roag-portal.ru/recommendations_gynecology Accessed: 14.03.2022 (in Russian).
8. Chimbira TH, Anderson ABM, Naish C, et al. Reduction of menstrual blood loss by danazol in unexplained menorrhagia: lack of effect of placebo. Br J Obstet Gynaecol. 1980;87:1152-8.
9. Jensen JT, Parke S, Mellinger U, et al. Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial. Obstet Gynecol. 2011;117:777-87.
10. Mansour D. Modern management of abnormal uterine bleeding – the levonorgestrel intra-uterine system. Best Pract Res Clin Obstet Gynaecol. 2007;21:1107-21.
11. Lukes AS, Moore KA, Muse KN, et al. Tranexamic acid treatment for heavy menstrua lbleeding: a randomized controlled trial. Obstet Gynecol. 2010;116:865-75.
12. Zozulia NI, Kumskova MA, Likhacheva EA, Svirin PV. Klinicheskie rekomendatsii po diagnostike i lecheniiu bolezni Villebranda, 2014. Available at: https://npngo.ru/uploads/media_document/287/847cfffc-3420-4475-93ee-b1832519bb46.pdf Accessed: 14.03.2022 (in Russian).
13. Bradley LD, Ndeye-Aicha Gueye. The medical management of abnormal uterine bleeding in reproductive-aged women. AJOG. 2016;31-44.
14. Bryant-Smith AC, Lethaby A, Farquhar C, Hickey M. Antifibrinolytics for heavy menstrual bleeding. Cochrane Database Syst Rev. 2018(4):CD000249.
15. Cai J, Ribkoff J, Olson S, et al. The many roles of tranexamic acid: an overview of the clinical indications for TXA in medical and surgical patients. Eur J Haematol. 2020(104):79-87.
16. Gleeson NC. Cyclic changes in endometrial tissue plasminogen activator and plasminogen activator inhibitor type 1 in women with normal menstruation and essential menorrhagia. Am J Obstet Gynecol. 1994;171:178-83.
17. Fraser IS, Porte RJ, Kouides PA, Lukes AS. A benefit-risk review of systemic haemostatic agents. Part 1: in major surgery. Drug Saf. 2008;31(3):217-30.
18. Roberts I, Shakur-Still H, Afolabi A, et al. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an inter- national randomised, double-blind, placebo-controlled trial. Lancet. 2020;395:1927-36.
19. Chornenki NLJ, Um KJ, Mendoza PA, et al. Risk of venous and arterial thrombosis in non-surgical patients receiving systemic tranexamic acid: a systematic review and meta-analysis. Thromb Res [Internet]. 2019;179:81-86. DOI:10.1016/j.throm res.2019.05.003
20. Okamoto S, Okamoto U. Amino-methyl-cyclohexane-carboxylic acid: AMCHA. A new potent inhibitor of fibrinolysis. Keio J Med. 1962;11:105-15.
21. Relke N, Chornenki NLJ, Sholzberg M. Res Pract Thromb Haemost. 2021;5:e12546.
22. Mannucci PM. Hemostatic drugs. NEJM. 1998;339:245-53.
23. Thorne JG, James PD, Reid RL. Heavy menstrual bleeding: is tranexamic acid a safe adjunct to combined hormonal contraception? Contraception. 2018;98(1):1-3. DOI:10.1016/j.contraception.2018.02.008
24. Pomp ER, Lenselink AM, Rosendaal FR, Doggen CJM. Pregnancy, the postpartum period and prothrombotic defects: risk of venous thrombosis in the MEGA study. J Thromb Haemost. 2008;6:632-7.
25. Heinemann LAJ, Dinger JC. Range of published estimates of ve- nous thromboembolism incidence in young women. Contraception. 2007;75:328-36.
26. Klok FA, Schreiber K, Stach K, et al. Oral contraception and men- strual bleeding during treatment of venous thromboembolism: ex- pert opinion versus current practice. Thromb Res. 2017;153:101-7.
27. La S, Warner GT, Cope E. Treatment of menorrhagia with tranexamic acid. a double-blind trial summary: a double-blind trial. Br Med J.1970;4:214-6.
28. Reid RL, Westhoff C, Mansour D, et al. Oral contraceptives and ve- nous thromboembolism: consensus opinion from an international workshop held in Berlin, Germany in December 2009. J Fam Plan Reprod Heal Care. 2010;36:117-22.
29. Lethaby A, Farquhar C, Hickey M. Antifibrinolytics for heavy menstrual bleeding (Review). Cochrane Database Syst Rev. 2018;1-76.
30. Ker K, Roberts I, Chaudhri R, et al. Tranexamic acid for the pre- vention of postpartum bleeding in women with anaemia: study protocol for an international, randomised, double-blind, placebo- controlled trial. Trials. 2018;19:1-19.
31. Nichols WL, Hultin MB, James AH, et al. Von Willebrand disease (VWD): evidence-based diagnosis and management guidelines, the National Heart, Lung, and Blood Institute (NHLBI) Expert Panel report (USA). Haemophilia. 2008;14(2):171-232.
32. Bradley LD, Gueye N-A. The medical treatment of abnormal uterine bleeding in reproductive-aged women. Am J Obstet Gynecol. 2016;214(1):31-44.
33. Connell NT, Flood VH, Brignardello-Petersen R, et al. ASH ISTH NHF WFH 2021 guidelines on the management of von Willebrand disease. Blood Adv. 2021;5:301-25.
34. Lin H, Xu L, Yu S, et al. Therapeutics targeting the fibrinolytic system. Exp Mol Med. 2020;52:367-79.

Авторы

М.А. Виноградова*

ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова» Минздрава России, Москва, Россия
*mary-grape@ya.ru

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Maria A. Vinogradova*

Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia
*mary-grape@ya.ru

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