title: No increased systemic fibrinolysis in women with heavy menstrual bleeding.
abstract: BACKGROUND
  Bleeding disorders have been recognized as important etiologic or contributory factors in women with heavy menstrual bleeding. Fibrinolysis in the endometrium plays a role in heavy menstrual bleeding. It is unknown whether increased systemic fibrinolysis might also increase the risk of heavy menstrual bleeding.
  
  
  OBJECTIVE
  To investigate fibrinolytic parameters, including clot lysis time, in women with heavy menstrual bleeding.
  
  
  METHODS
  We included 102 patients referred for heavy menstrual bleeding (Pictorial Bleeding Assessment Chart score of > 100) in our cohort. Patients and controls (28 healthy volunteers without heavy menstrual bleeding) underwent hemostatic testing in the first week after menstruation. For 79 patients and all controls, fibrinolytic parameters (thrombin-activatable fibrinolysis inhibitor activity, and plasminogen activator inhibitor-1, tissue-type plasminogen activator and plasmin inhibitor levels) and clot lysis time were available.
  
  
  RESULTS
  Fibrinolytic parameters were similar between patients and controls, except for thrombin-activatable fibrinolysis inhibitor (89.4% vs. 82.5%) and plasmin inhibitor (106% vs. 96%), the levels of which which were significantly higher in patients. In women with menorrhagia without gynecologic abnormalities, we found lower thrombin-activatable fibrinolysis inhibitor and plasminogen activator inhibitor-1 levels than in women with gynecologic abnormalities (thrombin-activatable fibrinolysis inhibitor, 85.4% vs. 94.8%; plasminogen activator inhibitor-1, 16.0 μg L(-1) vs. 24.5 μg L(-1) ).
  
  
  CONCLUSIONS
  Systemic fibrinolytic capacity is not increased in women with heavy menstrual bleeding. Overall, levels of the fibrinolytic inhibitors thrombin-activatable fibrinolysis inhibitor and plasmin inhibitor were even higher in patients than in controls. However, in a subgroup of women without gynecologic abnormalities, relatively lower levels of inhibitors may contribute to the heavy menstrual bleeding.
authors: Division of Hemostasis and Thrombosis, Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors: S
authors: S
authors: Wiewel-Verschueren
authors: H M
authors: HM
authors: Knol
authors: T
authors: T
authors: Lisman
authors: D H
authors: DH
authors: Bogchelman
authors: J C
authors: JC
authors: Kluin-Nelemans
authors: A G J
authors: AG
authors: van der Zee
authors: A B
authors: AB
authors: Mulder
authors: K
authors: K
authors: Meijer
mesh_terms: D000328:Adult; D001777:Blood Coagulation; D001780:Blood Coagulation Tests; D015992:Body Mass Index; D025901:Carboxypeptidase B2 / Q000378:metabolism*; D016022:Case-Control Studies; D004717:Endometrium / Q000378:metabolism* / Q000473:pathology; D005260:Female; D005342:Fibrinolysis; D064368:Healthy Volunteers; D006470:Hemorrhage / Q000150:complications; D006487:Hemostasis; D006801:Humans; D008595:Menorrhagia / Q000150:complications*; D008598:Menstruation; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000378:metabolism*
chemical_list: D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D025901:Carboxypeptidase B2
keywords: clot lysis time; fibrin; fibrinolysis; menorrhagia; plasminogen activator inhibitor 1; thrombin-activatable fibrinolysis inhibitor