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Thromboembolism and in vitro fertilization - a systematic review

Forskningsöversiktsartikel
Författare M. Sennstrom
K. Rova
M. Hellgren
R. Hjertberg
E. Nord
L. Thurn
P. G. Lindqvist
Human Reproduction V. P. Ne B
Publicerad i Acta Obstetricia Et Gynecologica Scandinavica
Volym 96
Nummer/häfte 9
Sidor 1045-1052
ISSN 0001-6349
Publiceringsår 2017
Publicerad vid Institutionen för kliniska vetenskaper, sektionen för kvinnors och barns hälsa, Avdelningen för obstetrik och gynekologi
Sidor 1045-1052
Språk English
Länkar doi.org/10.1111/aogs.13147
Ämnesord Pregnancy, assisted reproduction, high-risk pregnancy, thromboembolism, in vitro fertilization, OVARIAN HYPERSTIMULATION SYNDROME, MOLECULAR-WEIGHT HEPARIN, ASSISTED, REPRODUCTIVE TECHNOLOGY, VEIN-THROMBOSIS, VENOUS THROMBOSIS, RISK-FACTORS, BLOOD-COAGULATION, PREGNANCY, THROMBOPROPHYLAXIS, COMPLICATIONS
Ämneskategorier Reproduktionsmedicin och gynekologi

Sammanfattning

IntroductionThere is no accepted consensus on thromboprophylaxis in relation to in vitro fertilization (IVF). We aimed to study the frequency of thromboembolism and to assess thromboprophylaxis in relation to IVF. Material and methodsWe performed a systematic review. All study designs were accepted except single case reports. Language of included articles was restricted to English. ResultsOf 338 articles, 21 relevant articles (nine cohort studies, six case-control studies, three case series, and three reviews of case series) were identified. The antepartum risk of venous thromboembolism (VTE) after IVF is doubled (odds ratio 2.18, 95% CI 1.63-2.92), compared with the background pregnant population. This is due to a 5- to 10-fold increased risk during the first trimester in IVF pregnancies, in turn related to a very high risk of VTE after ovarian hyperstimulation syndrome (OHSS), i.e. up to a 100-fold increase, or an absolute risk of 1.7%. The interval from embryo transfer to VTE was 3-112 days and the interval from embryo transfer to arterial thromboembolism was 3-28 days. No robust study on thromboprophylaxis was found. ConclusionsThe antepartum risk of VTE after IVF is doubled, compared with the background pregnant population, and is in turn related to a very high risk of VTE after OHSS in the first trimester. We recommend that IVF patients with OHSS be prescribed low-molecular-weight heparin during the first trimester, whereas other IVF patients should be given thromboprophylaxis based on the same risk factors as other pregnant women.

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