Ovarian vein thrombosis: Incidence of recurrent venous thromboembolism and survival

Ewa M. Wysokinska; David Hodge; Robert D. McBane II

doi:10.1160/TH06-03-0151

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2006; 96(02): 126-131
DOI: 10.1160/TH06-03-0151

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Ovarian vein thrombosis: Incidence of recurrent venous thromboembolism and survival

Ewa M. Wysokinska

¹Division of Cardiovascular Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA

²Medical University Clinical Hospital of Wroclaw, Poland

,

David Hodge

⁴Division of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA

,

Robert D. McBane II

¹Division of Cardiovascular Medicine, Mayo Clinic and Foundation, Rochester, Minnesota, USA

³Division of Hematology, Mayo Clinic and Foundation, Rochester, Minnesota, USA

› Author Affiliations

Abstract

Summary

For patients with ovarian vein thrombosis (OVT), neither the rate of recurrence nor the expected survival are well established. Clarification of these natural history data would aid in defining the optimal management. We studied all female patients with OVT seen at the Mayo Clinic between 1990 and 2006. Survival, recurrent venous thrombosis rates, and prothrombotic factors were compared to a randomly selected group of 114 female patients with lower extremity venous thrombosis (DVT). Patients with OVT (n=35; mean age 44.8 ± 17.9 years) were significantly more likely to be under hormonal stimulation (48%), have an underlying malignancy (34%), experienced recent pelvic infection (23%) or undergone recent surgery (20%), compared to DVT patients. Duringa mean follow-up period of 34.6 ± 44.3 months, three patients suffered three recurrent venous thrombi (event rate: three per 100 patient years of follow-up).This recurrence rate was comparable to patients with lower extremity DVT (2.2 per 100 patient years). Recurrent thrombosis involved the contralateral ovarian vein, left renal vein, and inferior vena cava. The five-year mortality rate for OVT patients was 43% compared to 20% for DVT patients (p=0.08). All OVT deaths were cancer related. Survival was greater in OVT patients without cancer compared to those with active cancer (p<0.0001). In conclusion, venous thromboembolism recurrence rates are low and comparable to lower extremity DVT. Therefore general treatment guidelines for lower extremity DVT may be applicable. Poor survival rates in OVT are principally governed by the presence of malignancy.

Keywords

Ovarian vein - venous thrombosis - hormones

Full Text

References

References
1 Duff P, Gibbs RS. Pelvic vein thrombophlebitis: diagnostic dilemma and therapeutic challenge. Obstet Gynecol Surv 1983; 38: 365-73.
2 Brown CE, Stettler RW, Twickler D. et al. Puerperal septic pelvic thrombophlebitis: Incidence and response to heparin therapy. Am J Obstet Gynecol 1999; 181: 143-8.
3 Witlin AG, Sibai BM. Postpartum Ovarian Vein Thrombosis after Vaginal delivery:a report of 11 cases. Obstet Gynecol 1995; 85: 775-80.
4 Witlin AG, Mercer BM, Sibai BM. Septic pelvic thrombophlebitis or refractory postpartum fever of undetermined etiology. J Matern-Fetal Med 1996; 05: 355-8.
5 Dessole S, Capobianco G, Arru A. et al. Postpartum ovarian vein thrombosis: an unpredictable event: two case reports and review of the literature. Arch Gynecol Obstet 2003; 267: 242-6.
6 Benfayed WH, Torreggiani WC, Hamilton S. Detection of pulmonary emboli resulting from ovarian vein thrombosis. AJR 2003; 181: 1430-1.
7 Salomon O, Apter S, Shaham D. et al. Risk factors associated with postpartum ovarian vein thrombosis. Thromb Haemost 1999; 82: 1015-9.
8 Al-toma A, Heggelman BGF, Kramer MHH. Postpartum ovarian vein thrombosis: report of a case and review of literature. The Neth J Med 2003; 61: 334-6.
9 Ortin X, Ugarizza A, Espax RM. et al. Postpartum ovarian vein thrombosis. Thromb Haemost 2005; 93: 1004-5.
10 Dure-Smith P. Ovarian syndrome: is it a myth?. Urology 1979; 13: 355-64.
11 Gayer G. Ovarian vein thrombosis- Computerized Tomography diagnosis. IMAJ 2001; 03: 627-8.
12 Horne 3rd MK, Figg WD, Arlen P. et al. Increased frequency of venous thromboembolism with the combination of docetaxel and thalidomide in patients with metastatic androgen-independent prostate cancer. Pharmacotherapy 2003; 23: 315-8.
13 Jacoby WT, Cohan RH, Baker ME. et al. Ovarian vein thrombosis in Oncology patients: CT detection and clinical significance. AJR 155: 291-4.
14 Quane LK, Kidney DD, Cohen AJ. Unusual causes of ovarian vein thrombosis as revealed by CT and sonography. AJR 1998; 171: 487-90.
15 Yassa NA, Ryst E. Ovarian vein thrombosis: a common incidental finding in patients who have undergone total abdominal hysterectomy and bilateral salpingooophorectomy with retroperitoneal lymph node dissection. AJR 1999; 172: 45-7.
16 Smith MD, Felker RE, Emerson DS. et al. Sonographic visualization of ovarian veins during the puerperium: An assessment of efficacy. Am J Obstet Gynecol 2002; 186: 893-5.
17 Sherer DM, Fern S, Mester Y. et al. Postpartum ultrasonographic diagnosis of inferior vena cava thrombus associated with ovarian vein thrombosis. Am J Obstet Gynecol 1997; 177: 474-5.
18 Kubik-Huch RA, Hebisch G, Huch R. et al. Role of duplex color Doppler ultrasound, computed tomography, and MR angiography in the diagnosis of septic puerperal ovarian vein thrombosis. Abdom Imaging 1999; 24: 85-91.
19 Yildrim E, Kanbay M, Ozbek O. et al. Isolated idiopathic ovarian vein thrombosis: a rare case. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16 (04) 308-10.
20 Comp PC, Thurnau GR, Welsh J. et al. Functional and immunologic proteinS levels are decreased during pregnancy. Blood 1986; 68: 881-5.
21 Olson JD. Laboratory diagnosis of thrombophilia: Why, who, what, when, how to test. Lab Hematol 2004; 10: 172.
22 Büller HR, Agnelli G, Hull RD. et al. Antithrombotic Therapy for Venous Thromboembolic Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126: 401S-28S.