{"paper_id":"61eee4ec-c109-4864-b572-61980a8b573f","body_text":"The effect of oral contraceptive on coagulation function was mainly related to estrogen. Early literature showed that there was a risk of thrombosis caused by oral contraceptive, such as Marvelon. It could lead to 8.6/millions fatal venous thrombosis, especially when the patient complicated with genetic defects which could induce thrombosis. It was also found that the risk of thrombosis due to oral contraceptives was not increased during therapy time, the greatest risk was in the 1 st  year.[ 1 ] The patient in this study had a history of taking Marvelon orally for nearly 6 months; it might be one of the risk factors that led to high coagulation in blood.\n\nIn 2012, Yamashiro  et al .[ 2 ] reported 4 cases of adenomyosis complicated with cerebral infarction. This same team reported a case of adenomyosis patient with occurrence of cerebral thrombosis without apparent cause in 2014.[ 3 ] The authors thought blood loss anemia caused by adenomyosis and elevated levels of CA125 could promote the high coagulation state and lead to cerebral thrombosis. There were many studies taking anemia as a risk factor of embolism. By investigating its pathogenesis, some people thought that was due to thrombocytosis after anemia, but other theories thought that[ 4 ] quantity of platelet did not increase when anemia, the thrombosis was caused by hematic high coagulation state because of long-time blood loss. Moreover, some studies indicated that hypoxia damage of terminal arteries caused by anemia would result in thrombosis. CA125 was a marker of epithelial ovarian tumor, and a kind of sticky protein that could lead to hematic high coagulation state. This case had long-term severe blood loss anemia, accompanied by abnormally high CA125 level, these factors made blood in a high coagulation state for a long time, and eventually led to thrombosis on a stimulation of E2 peak caused by GnRH-a.\n\nNotably, the patient was diagnosed as CAPS finally. The titers of ACA of the patient were not high, but β2-glycoprotein 1 IgAGM antibody was continuing positive for a period of 6 weeks. Positive result of antiphospholipid antibodies was one of the high risk factors of thrombosis. It was reported[ 5 ] that β2-glycoprotein 1 antibody had strong correlation with thrombosis. Because of the limitation of our clinical laboratory, we could not examine other coagulation factors, such as protein C or S, antithrombin III. Deficiencies of those factors were also the cause of embolism.\nIn conclusion, this case of thrombosis may be multi-factorial, but the occurrence of thrombosis had close temporal relationship to GnRH-a administration. Many investigations believed that GnRH-a could reduce inflammation and angiogenesis, relieve pain, improve anemia condition, and could be considered as an effective therapy to preserve the uterus. The case suggested that GnRH-a should be used with caution in adenomyosis patients who had recently used oral contraceptive agents or other estrogenic drugs, chronic severe anemia, or high CA125. Coagulation function should be checked before the use of GnRH-a, perhaps, it should be used after anemia has been corrected and blood coagulation status has been improved. It may be necessary to give prophylactic anticoagulation therapy in high coagulation state. More importantly, we should inform patients about the risk of thromboembolism.\nNil.\nThere are no conflicts of interest.","source_license":"CC0","license_restricted":false}