Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a rare and potentially life-threatening complication of infertility treatment occurring during either the luteal phase or early pregnancy. An increasing number of thromboembolic complications associated with the increased use of assisted reproductive techniques have been reported in the literature. Identification of the risk factors is crucial for prevention of thromboembolic events in OHSS patients. Alterations in the hemostatic system cause hypercoagulability in women affected by severe OHSS. Coexistence of inherited hypercoagulable conditions increases the risk of thromboembolism. The role of clinical parameters that can help predict development of thrombosis is controversial. Patients with a personal or family history of thrombosis undergoing infertility treatment should be considered for thrombophilia screening, while routine examination of inherited thrombophilic mutations is not indicated in infertile patients. Antithrombotic primary prevention is not indicated in healthy women undergoing assisted reproductive procedures or in women with thrombophilia. Anticoagulant therapy is indicted if there is clinical evidence of thrombosis or laboratory evidence of hypercoagulability. In this review, the risks of hypercoagulability in the OHSS are discussed.Sindrom hiperstimulacije jajnika je rijetka i za život opasna komplikacija liječenja neplodnosti koja se javlja u lutealnoj fazi menstruacijskog ciklusa ili tijekom rane trudnoće. Povećanjem zastupljenosti tehnika potpomognute oplodnje povećava se broj prijavljenih slučajeva tromboembolijskih komplikacija. U prevenciji tromboembolijskih događaja kod bolesnica sa sindromom hiperstimulacije jajnika ključno je određivanje rizičnih čimbenika. Promjene u sustavu hemostaze uzrokuju hipekoagulabilnost, a nasljedne trombofilije dodatno povećavaju rizik tromboembolije. Sporna je uloga kliničkih parametara koji mogu pomoći u predviđanju razvoja tromboze. Žene podvrgnute liječenju neplodnosti koje su preboljele tromboembolijsku bolest ili u obitelji imaju slučajeve tromboembolijske bolesti treba testirati na nasljedne trombofilije, dok se rutinsko testiranje kod neplodnih žena ne provodi. Antitrombotska terapija je indicirana samo ako su prisutni klinički znakovi tromboze ili laboratorijski dokazana hiperkoagulabilnost, a nije indicirana kod žena s nasljednom trombofilijom u postupku medicinski potpomognute oplodnje bez kliničkih i/ili laboratorijskih znakova tromboze. U ovom preglednom članku opisani su rizici hiperkoagulabilnosti u sindromu hiperstimulacije jajnika
