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Riva N, Muscat-Baron L, Vassallo C, Ageno W, Rottenstreich A, Sauvé N, Wysokinski WE, Goldberg GL, Salomon O, Labropoulos N, Foulon A, AlSheef M, Gatt A, Calleja-Agius J. Safety and efficacy of anticoagulant treatment in patients with ovarian vein thrombosis: a systematic review and meta-analysis of observational studies. Res Pract Thromb Haemost 2024; 8:102501. [PMID: 39175528 PMCID: PMC11339252 DOI: 10.1016/j.rpth.2024.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/24/2024] [Accepted: 06/14/2024] [Indexed: 08/24/2024] Open
Abstract
Background The role of anticoagulation in ovarian vein thrombosis (OVT) is uncertain. Objectives We aimed to evaluate safety and efficacy of anticoagulant treatment in OVT patients. Methods A systematic search was conducted in MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases up to April 2024. Eligible studies included randomized controlled trials and observational studies enrolling at least 10 adult patients with objectively diagnosed OVT and treated with any anticoagulants. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42021270883). Results We included 17 observational studies (621 anticoagulated and 376 nonanticoagulated OVT patients); 9 studies enrolled mainly pregnancy/puerperium-related OVT. Most patients received heparins alone (45.7%) or proceeded to vitamin K antagonists (39.2%). The average treatment duration was ≤3 months in 8 studies (47.1%), >3 to ≤6 months in 6 studies (35.3%), and >6 months in 3 studies (17.6%). In treated patients, mortality rate was 2.43% (95% CI, 0.54%-5.41%; I2 = 53.8%; 12/406 patients; 13 studies), major bleeding was 1.27% (95% CI, 0.48%-2.38%; I2 = 2.5%; 7/583 patients; 15 studies), recurrent venous thromboembolism (VTE) was 3.49% (95% CI, 1.12%-6.95%; I2 = 63.5%; 22/482 patients; 15 studies), and vessel recanalization was 89.4% (95% CI, 74.6%-98.6%; I2 = 80.6%; 163/184 patients; 8 studies). The rate of recurrent VTE in untreated patients was 8.65% (95% CI, 2.61%-17.35%); however, the difference compared with treated patients was not statistically significant (risk ratio, 0.70; 95% CI, 0.36-1.37). At subgroup analyses, the rates of major bleeding and recurrent VTE were 0.80% (95% CI, 0.0-2%.17%) and 3.81% (95% CI, 0.42%-9.63%) in pregnancy/puerperium-related OVT, respectively, and 1.12% (95% CI, 0.32%-2.34%) and 1.78% (95% CI, 0.62%-3.46%), respectively, when analyzing only full-text studies. Conclusion There is paucity of literature regarding OVT. Our results suggest that anticoagulation is associated with low rates of major bleeding and recurrent VTE.
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Affiliation(s)
- Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Lorna Muscat-Baron
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Carine Vassallo
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Amihai Rottenstreich
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
- Laboratory of Blood and Vascular Biology, Rockefeller University, New York, New York, USA
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nadine Sauvé
- Division of Internal Medicine, Department of Medicine, University of Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Gary L. Goldberg
- Department of Obstetrics and Gynecology, Gynecologic Oncology, Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Medical Center, Northwell Health Cancer Institute, New Hyde Park, New York, USA
| | - Ophira Salomon
- Thrombosis Unit, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Nicos Labropoulos
- Department of Surgery, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Arthur Foulon
- Obstetrics and Gynecology Department, Amiens University Center, Picardie Jules Verne University, Amiens, France
| | - Mohammed AlSheef
- Internal Medicine and Thrombosis, Medical Specialties Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Alex Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Cheung W, Stegwee S, van Hamont D, Visser J. Postpartum ovarian vein thrombosis with left renal venous infarction after vaginal delivery. BMJ Case Rep 2024; 17:e258877. [PMID: 38442978 PMCID: PMC10916174 DOI: 10.1136/bcr-2023-258877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
A primipara in her late 20s presented with abdominal pain and pain in the left flank 14 days after a ventouse delivery. She was treated with antibiotics, antiemetics and analgesics with the initial differential diagnosis of cystitis, pyelonephritis or nephrolithiasis. Despite the treatment, the patient experienced increased colic pain and nausea. An ultrasound showed an enlarged left kidney, suggesting pyelonephritis, and thereby, the antibiotic treatment was adjusted accordingly. Despite additional pain medication, pain relief could not be achieved. The diagnosis of ovarian venous thrombosis was considered, and an abdominal CT scan confirmed the diagnosis. The patient was treated with anticoagulant therapy. Hypercoagulability work-up revealed a heterozygous mutation of the Factor V Leiden. Our patient awaits a haematologic follow-up.
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Affiliation(s)
- Wingman Cheung
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Sanne Stegwee
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dennis van Hamont
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
| | - Jantien Visser
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, The Netherlands
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Zhen S, Kodesh A, Preston W. Idiopathic left-sided ovarian vein thrombosis in a post-menopausal woman. BMJ Case Rep 2023; 16:e257856. [PMID: 38061852 PMCID: PMC10711862 DOI: 10.1136/bcr-2023-257856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Ovarian vein thrombosis (OVT) is a rare thromboembolic condition largely involving the right ovarian vein. Risk factors include pregnancy/ peripartum period, oestrogen therapy, recent surgery or hospitalisation, malignancy, pelvic inflammatory diseases, and thrombophilia; OVT without risk factors is considered idiopathic. We present a rare case of idiopathic left-sided OVT in a post-menopausal woman in her 60s with insignificant past medical history and no identifiable risk factors. She presented with isolated left -lower -quadrant abdominal pain ultimately found to have OVT on computed tomography (CT) scan and confirmed with magnetic resonance imaging (MRI). The patient was initially treated with low-molecular-weight heparin and then transitioned to apixaban. She remained symptom-free at 3-month follow-up. Five previous cases of idiopathic left-sided OVT have been reported to-date, but this is the first case in a postmenopausal woman that has not been associated with hypercoagulable risk factors nor further thromboembolic complications.
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Affiliation(s)
- Simon Zhen
- Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Montefiore Medical Center, Bronx, New York, USA
| | - Afek Kodesh
- Montefiore Medical Center, Bronx, New York, USA
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Muscat-Baron L, Borg AL, Attard LM, Gatt A, Riva N. Cancer-Associated Abdominal Vein Thrombosis. Cancers (Basel) 2023; 15:5293. [PMID: 37958466 PMCID: PMC10649304 DOI: 10.3390/cancers15215293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Cancer is associated with an increased risk of developing venous thromboembolism, due to its direct influence on the three pillars of Virchow's triad (e.g., compression on the blood vessels by the tumour, blood vessels invasion, and cytokine release), together with the effect of exogenous factors (such as chemotherapy, radiotherapy, surgery). In cancer patients, the risk of thrombosis at unusual sites, such as splanchnic, ovarian and renal vein thrombosis, is also increased. Abdominal vein thromboses are frequently incidental findings on abdominal imaging performed as part of the diagnostic/staging workup or the follow-up care of malignancies. There is little evidence on the management of unusual site venous thromboembolism in cancer patients since there are only a few specific recommendations; thus, the management follows the general principles of the treatment of cancer-associated deep vein thrombosis and pulmonary embolism. This narrative review summarises the latest evidence on cancer-associated abdominal vein thrombosis, i.e., thrombosis of the splanchnic, ovarian and renal veins.
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Affiliation(s)
- Lorna Muscat-Baron
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
| | - Amber Leigh Borg
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
| | - Laura Maria Attard
- Medical School, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta; (L.M.-B.); (A.L.B.); (L.M.A.)
| | - Alex Gatt
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
| | - Nicoletta Riva
- Department of Pathology, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta;
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Li J, Zhou M, He C, Liang F. Group B Streptococcus infection-induced ovarian vein thrombosis identified during cesarean section: A case report and a literature review. Medicine (Baltimore) 2023; 102:e34141. [PMID: 37352049 PMCID: PMC10289690 DOI: 10.1097/md.0000000000034141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/08/2023] [Indexed: 06/25/2023] Open
Abstract
RATIONALE Ovarian vein thrombosis (OVT) is a rare yet potentially life-threatening condition associated with thromboembolic events. Group B Streptococcus (GBS) is a type of β-hemolytic Gram-positive bacterium known for asymptomatic colonization in the lower genital and gastrointestinal tracts. Here we reported a 35-year-old multiparous woman with gestational diabetes who suffered from placental abruption, stillbirth, OVT, septic shock, and renal failure due to severe GBS infection. PATIENT CONCERNS A 35-year-old woman with gestational diabetes presented with acute and sustained lower abdominal cramping, vaginal bleeding, and fever at 35 gestational weeks. DIAGNOSES Based on preoperative ultrasound and intraoperative findings, the patient was diagnosed with placental abruption, intrauterine fetal demise, and right OVT. GBS was cultured from the amniotic fluid obtained during cesarean section. INTERVENTIONS The patient underwent a right adnexectomy during a cesarean section and received intravenous antibiotics. Subsequently, an ultrasound-guided uterine curettage was performed due to recurrent fever. OUTCOMES After a prolonged course of intravenous antibiotics for over a month, the patient recovered and was discharged from the hospital. LESSONS This case underscores the need for early initiation of anticoagulant protocols in cases of OVT, particularly when GBS infection is identified as a predisposing factor. Further research and awareness are warranted to better understand the relationship between GBS infection and OVT and to optimize management strategies in such cases.
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Affiliation(s)
- Jianqiong Li
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Meifang Zhou
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chaoman He
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fengbing Liang
- Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, School of Medicine, Zhejiang University, Hangzhou, China
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Ahmed M, Mendha T, Do V, Carlan S, Madruga M. Ovarian Vein Thrombosis: An Unusual Cause of Abdominal Pain in Breast Cancer. Cureus 2023; 15:e37363. [PMID: 37181988 PMCID: PMC10170570 DOI: 10.7759/cureus.37363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Ovarian vein thrombosis (OVT) is a rare but potentially life-threatening complication that is usually seen in the intrapartum or postpartum period but can also be seen in patients with risk factors for venous thromboembolism. When symptomatic, it usually presents with abdominal pain and other vague constitutional symptoms, hence it is important for healthcare professionals to be aware of this condition when evaluating patients with risk factors. We present a rare case of OVT in a patient with breast cancer. Due to a lack of clear guidelines regarding the treatment and duration of treatment in non-pregnancy-related OVT, we followed the guidelines for the treatment of venous thromboembolism and started the patient on rivaroxaban for a three-month duration with close outpatient follow-up.
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Affiliation(s)
- Madiha Ahmed
- Internal Medicine, Orlando Regional Medical Center, Orlando, USA
| | - Taaha Mendha
- Internal Medicine, University of Miami, Miller School of Medicine, Miami, USA
| | - Van Do
- Internal Medicine, Orlando Regional Medical Center, Orlando, USA
| | - Steve Carlan
- Obstetrics, Orlando Regional Medical Center, Orlando, USA
| | - Mario Madruga
- Internal Medicine, Orlando Regional Medical Center, Orlando, USA
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