Coagulation function changes after high-intensity focused ultrasound therapy for uterine fibroids and adenomyosis: a large retrospective cohort study

OBJECTIVE: High-intensity focused ultrasound (HIFU) therapy is increasingly used in the management of various solid tumors. However, limited data are available regarding the association between HIFU treatment and coagulation function. MATERIALS AND METHODS: A total of 1,189 patients diagnosed with uterine fibroids or adenomyosis who underwent HIFU therapy at Shanghai First Maternal and Infant Hospital between August 2015 and November 2020 were included. Paired t-tests were conducted to compare coagulation indicators measured before and after HIFU treatment. Multiple logistic regression models were used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to evaluate the association between the risk of elevated D-dimer/fibrinogen degradation products (FDP) and HIFU treatment parameters categorized into tertiles. RESULTS: A total of 1,148 eligible patients were included in the final analysis. After HIFU treatment, 61.8% and 55.7% of patients showed elevated D-dimer and FDP levels, respectively, and 54.6% exhibited simultaneous elevation of both on the first day after treatment. Other post-treatment coagulation indicators also demonstrated a hypercoagulable state, including prolonged prothrombin time and thrombin time, shortened activated partial thromboplastin time, and decreased platelet count. During follow-up, no patients developed thromboembolism. Several HIFU parameters were associated with increased D-dimer and FDP levels. The highest tertile of exposure energy was significantly associated with a greater risk of simultaneous elevation of both D-dimer and FDP (adjusted OR [95% CI]: 4.58 [3.17, 6.66]). CONCLUSION: Higher exposure energy during HIFU treatment may induce alterations in coagulation function, resulting in a transient post-treatment hypercoagulable state.