Different prophylactic measures for preventing postoperative deep venous thromboembolism in adenomyosis: a retrospective study

Abstract

Objective  To investigate the incidence of postoperative venous thromboembolism in women with uterine adenomyosis treated using different surgical methods, and to evaluate the associated clinical and laboratory parameters, including thromboembolism assessment after laparoscopic excision of adenomyosis.

Methods  (1) A retrospective collection of clinical data was conducted for 411 women with uterine adenomyosis and 33 women without adenomyosis who underwent surgical treatment at Hubei Provincial Maternal and Child Healthcare Hospital from March 2020 to December 2022. The clinical data, surgical methods, and preoperative and postoperative coagulation parameters were compared between the two groups. (2) The incidence of venous thromboembolism in women with and without uterine adenomyosis was analyzed. (3) The differences in the incidence of venous thromboembolism among women with uterine adenomyosis who underwent different surgical methods were analyzed, including clinical data and preoperative and postoperative coagulation parameters of women who did not experience venous thromboembolism. (4) The incidence of venous thromboembolism was compared between women receiving mechanical thromboprophylaxis and those receiving a combination of mechanical and pharmacological prophylaxis.

Results  (1) Comparative analysis of clinical data showed that women with uterine adenomyosis had fewer pregnancies and births, lower hemoglobin levels, and larger uterine volumes compared to women without adenomyosis (p < 0.05). There were no significant differences in preoperative and postoperative coagulation parameters between the two groups (p > 0.05). (2) The preoperative platelet count and postoperative d-dimer levels were higher in women with uterine adenomyosis than in those without adenomyosis (p < 0.05). (3) The incidence of venous thromboembolism was higher in the uterine adenomyosis group (9.78 %) than in the non-adenomyosis group (3.03 %). Among the women with uterine adenomyosis, the incidence of venous thromboembolism after laparoscopic lesion excision (18.46 %) was higher than that after laparoscopic hysterectomy (7.86 %). (4) Compared with the mechanical prophylaxis group, the mechanical plus pharmacological prophylaxis group had a significantly lower incidence of venous thromboembolism [18.52 % (15/81) vs. 7.62 % (25/328)], with a statistically significant difference (p < 0.05).

Conclusion  The incidence of postoperative venous thromboembolism is relatively high in women with uterine adenomyosis, particularly in those who underwent laparoscopic lesion excision. Even in the absence of typical symptoms and despite thromboprophylaxis, screening for venous thromboembolism should be considered within 7 days postoperatively.