Scripties UMCG - Rijksuniversiteit Groningen
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Bij verlaagde spiegels van stollingsfactor XI en von Willebrand factor geen winst meer van endometrium ablatie boven Mirena spiraal bij behandeling van menorragie : een exploratieve studie

(2018) Borselen, J.W. van (Joep)

Introduction: Heavy menstrual bleeding (HMB) is a common problem and affects quality of life. Low levels of von Willebrand factor (vWF) or factor XI (FXI) can result in HMB. Two frequently used therapies for HMB are the Mirena spiral and endometrial ablation (EA). Data on these treatment options in women with low levels of coagulation factors is scarce.
Objective: This study aims to discover whether vWF and FXI levels modify the relative effect of Mirena spiral versus EA.
Methods: We performed a sub-analysis within the MIRA trial that compared the Mirena spiral and EA as a treatment for HMB. In this multicenter randomized controlled trial, women aged 34 or older with a pictorial blood assessment chart (PBAC) > 150 were included. FXI and vWF levels were measured in some of the MIRA participants. Several binary logistic regressions were carried out. Primary outcome was a PBAC < 75 at 24 months.
Results: 95 women were included, 52 in EA group, 43 in Mirena group. 81 women had a PBAC < 75 at 24 months (88,2% in EA versus 85,7% in Mirena). The probability of PBAC < 75 is higher for women with coagulation levels above the median with an EA, compared with a Mirena spiral (OR=0,400, 95% CI=0,032-4,960). For women with coagulation levels below the median, the probability of a PBAC < 75 is for EA and Mirena spiral the same (OR=0,311, 95%CI=0,029-3,353 versus OR=0,300, 95%CI=0,035-2,555).
Conclusion: Reduced coagulation factors XI en von Willebrand seem to let EA lose its benefit over the Mirena spiral.

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