The abnormal coagulation status in endometriosis patients: a systematic review and meta-analysis.

OBJECTIVES

This study aimed to comprehensively examine coagulation parameters in patients with endometriosis versus those without to determine hematologic alterations associated with endometriosis.

METHODS

Embase, PubMed, CINAHL, Web of Science, the Cochrane Library, CBM, CNKI, VIP, and Wanfang Database were searched through June 2024. The Newcastle-Ottawa Scale was used to evaluate the quality of the studies. Statistical analyses were performed using Stata 16.0 software.

RESULTS

22 studies with 6,258 participants were included. The results showed significant abnormalities in coagulation parameters in patients with endometriosis compared to those without. Specifically, fibrinogen (FIB) (SMD = 0.57; 95%CI, 0.45 ~ 0.69; P < 0.001), D-dimer (D-D) (SMD = 0.62; 95%CI, 0.27 ~ 0.96; P < 0.001), and platelet count (PLT) (SMD = 0.28; 95%CI, 0.11 ~ 0.45; P = 0.001) were significantly elevated, while activated partial thromboplastin time (APTT) (SMD = -0.13; 95%CI, -0.22~-0.03; P = 0.010), prothrombin time (PT) (SMD = -0.31; 95%CI, -0.54~-0.08; P = 0.009), and thrombin time (TT) (SMD = -0.41; 95%CI, -0.63~-0.20; P < 0.001) were significantly reduced. Moreover, FIB (SMD = 0.47; 95%CI, 0.23 ~ 0.71; P < 0.001), D-D (SMD = 0.38; 95%CI, 0.10 ~ 0.66; P = 0.009), PT (SMD = -0.21; 95%CI, -0.41~-0.02; P = 0.030), and TT (SMD = -0.20; 95%CI, -0.38 ~ 0.01; P = 0.037) also vary between patients with stage I-II and stage III-IV endometriosis.

CONCLUSION

Multiple coagulation parameters were abnormal in endometriosis patients, indicating a hypercoagulable state, particularly pronounced in those with stage III-IV endometriosis. Large, globally representative prospective cohorts are needed to elucidate the causal relationship between endometriosis and hypercoagulability.