DOAC内服中に子宮鏡下子宮筋腫切除術を実施した１例

抄録

　In recent years, there has been an increasing trend to continue antithrombotic therapy perioperatively, considering the risks associated with interruption, but definitive guidelines are lacking. We report a case of hysteroscopic myomectomy in a patient with a submucosal uterine fibroid who was on direct oral anticoagulants (DOACs). The patient, a 34-year-old nulligravid woman, presented with menorrhagia due to a submucosal fibroid, initially treated with a low-dose oral contraceptive. She subsequently developed deep vein thrombosis of the lower extremity and pulmonary embolism. Despite anticoagulation therapy, residual thrombus remained in the lower leg veins, necessitating continued DOAC administration. Due to ongoing menorrhagia, a decision was made to perform hysteroscopic myomectomy. DOAC therapy was discontinued only on the morning of the surgery, and a local vasopressin injection was administered intraoperatively to minimize blood loss. The procedure was completed safely with minimal bleeding, DOAC therapy was resumed three hours postoperatively, and the patient's postoperative course was uneventful. Management of uterine fibroid surgery in patients undergoing anticoagulation therapy requires individualized assessment of the surgical approach and perioperative interruption of anticoagulation. There are few case reports on this topic, and additional data are needed to evaluate the safety of hysteroscopic procedures during ongoing anticoagulation therapy.