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

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. 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. 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]). Higher exposure energy during HIFU treatment may induce alterations in coagulation function, resulting in a transient post-treatment hypercoagulable state.