Thrombosis following ovarian hyperstimulation syndrome

Abstract

The aim of this review is to analyse the pathophysiology and complications of thrombosis in conjuction with ovarian hyperstimulation syndrome (OHSS) following ovulation induction and to suggest practical guidelines usefull for the prevention and treatment. Although the incidence of thrombosis varies from 0.2% among in vitro fertilization (IVF) cycles and up to 10% for severe cases of the syndrome, it represents the most dangerous complication of OHSS. Different changes in haemostatic markers have been found to create a state of hypercoagulability, but no single standard test is available to estimate the state of thrombosis. The role of markers for thrombophilia is controversial. Thromboses are mostly venous (67–75%) involving upper limbs and neck, then arterial (25–33%) which are mainly intracerebral. The predominant sites of venous thromboembolism in the upper part of the body may be explained by higher concentrations of estrogens drained through lymphatic ducts from ascites and by compression of rudimentary branchyal cysts. Once early diagnosis is established, it is crucial to use an anticoagulant treatment with heparin proceeded with thromboprophylaxis. However, identification of patients at risk and preventive measures of OHSS are the best means in reducing the risk of thrombosis after ovarian stimulation.

Chinese abstract

本综述的目的是分析促排卵导致的卵巢过度刺激综合征（OHSS）并发血栓形成的病理生理学特征与并发症，并针对其预防与治疗提出实用的临床指南。虽然体外受精治疗中血栓形成的发生率介于0.2∼10%之间，它却是OHSS最危险的并发症。现已发现了多种造成高凝状态的凝血标志物，但还没有单一的检验标准用于评估血栓形成的状态。关于标志物在血栓形成倾向中所起的的作用存在争议。血栓多为静脉血栓（67∼75%），包括上肢与颈部；而动脉血栓（25∼33%）多位于大脑内部。静脉血栓多位于身体上部，可能是由于腹水中较高浓度的雌激素经淋巴管排出，及残留囊肿的加压作用。一旦早期诊断确立，重要的是应用抗凝血剂治疗及肝素预防血栓。但是，鉴定高危患者与预防OHSS的发生是降低卵巢刺激后血栓风险的最好办法。

• Ovarian hyperstimulation syndrome
• pathophysiology
• prevention and treatment
• thrombosis