Is thromboprophylaxis cost effective in ovarian hyperstimulation syndrome: A systematic review and cost analysis

Wormer, Kelly C.; Jangda, Ayesha Altaf; Sayed, Farah A. El; Stewart, K.I.; Segars, James H.

doi:10.1016/j.ejogrb.2018.03.028

Cited by 13 publications

(7 citation statements)

References 65 publications

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“…The incidence of combined luteal rupture in pregnancy is about 13% of the pregnancy population, and the combination of OHSS and luteal rupture in twin pregnancies after IVF-ET is rarely reported and can be confused with a variety of gynecological emergencies. [7,8] This case should alert us to antagonist regimens and appropriate Gn initiation doses [9] should be chosen as much as possible in patients with ovarian hyper-responsiveness; the indications and dosages for the use of aspirin and low molecular heparin in IVF-ET should be strictly controlled [10,11] ; luteinizing support in IVF-ET should be avoided in multiple species overdose [12,13] ; anticoagulants should be discontinued promptly after the occurrence of bleeding disorders; after the occurrence of luteal rupture, conservative treatment can be taken for a certain period of time when the patient vital signs are stable and the disease is self-limiting in some patients. [14]…”

Section: Discussionmentioning

confidence: 99%

A case report of Ovarian hyperstimulation syndrome and corpus luteum rupture in twin pregnancies with IVF-ET

Luo¹,

Shen²,

et al. 2023

Medicine

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Introduction: Ovarian hyperstimulation syndrome (OHSS) is a common complication during assisted conception treatment, mostly seen in patients with ovarian hyperresponsiveness such as polycystic ovary syndrome, especially in post-invitro fertilization and embryo transfer (IVF-ET) pregnancies. Its main symptoms are abdominal distension, abdominal pain, nausea and vomiting with ascites, pleural fluid, leukocytosis, hemoconcentration and hypercoagulation. This disease is a self-limiting disease and can be gradually cured by rehydration, albumin infusion and correction of electrolyte disorders in moderate to severe cases. Luteal rupture is a more common gynecological emergency abdomen. The combination of twin pregnancy, OHSS and ruptured corpus luteum is very rare. We successfully avoided the stimulation of the risk of pregnancy abortion by surgical exploration through dynamic ultrasound monitoring and vital signs observation in the absence of experience in primary care, and the patient hard-won twin pregnancy was successfully treated conservatively. Patient concerns: The patient is a 30-year-old post-IVF-ET woman with an established twin pregnancy, OHSS and sudden onset of lower abdominal pain. Diagnosis: Twin pregnancy, OHSS combined with ruptured corpus luteum. Interventions: Rehydration, albumin infusion, low molecular heparin for thromboprophylaxis, luteinizing support, ambulatory ultrasound monitoring. Outcomes: After more than 10 days of standardized treatment for OHSS, dynamic ultrasound monitoring and close observation of vital signs, the patient was discharged cured of her condition and is continuing her pregnancy. Conclusion: Our case shows that the possibility of acute abdominal rupture of the corpus luteum is still present in the case of combined OHSS in pregnancy, and that some patients with corpus luteum rupture can heal spontaneously during close testing to avoid the increased risk of miscarriage with surgical exploration.

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Section: Discussionmentioning

confidence: 99%

A case report of Ovarian hyperstimulation syndrome and corpus luteum rupture in twin pregnancies with IVF-ET

Luo¹,

Shen²,

et al. 2023

Medicine

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“…Twenty-two papers were identified as being potentially relevant during the sift of titles and abstracts, summarised in Figure 29. 89,99,[134][135][136][137][138][139][140][141][142][143][144][145][146][147][148][149][150][151][152][153] Two papers reported the same economic evaluation and were therefore considered as one study. 89,143 Similarly, three papers reported the same economic evaluation and were therefore considered as one study.…”

Section: Suggested Research Prioritiesmentioning

confidence: 99%

“…Four analyses were not in relevant populations. 137,140,143,153 One was in patients with ovarian hyperstimulation syndrome (OHSS) and only a proportion of this population were pregnant. 137 Two studies compared alternative diagnostic strategies for pregnant women with suspected PE and were therefore neither relevant comparisons nor a relevant population.…”

Section: Suggested Research Prioritiesmentioning

confidence: 99%

Thromboprophylaxis during pregnancy and the puerperium: a systematic review and economic evaluation to estimate the value of future research

Davis,

Pandor,

Sampson

et al. 2024

Health Technol Assess

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Background Pharmacological prophylaxis to prevent venous thromboembolism is currently recommended for women assessed as being at high risk of venous thromboembolism during pregnancy or in the 6 weeks after delivery (the puerperium). The decision to provide thromboprophylaxis involves weighing the benefits, harms and costs, which vary according to the individual’s venous thromboembolism risk. It is unclear whether the United Kingdom’s current risk stratification approach could be improved by further research. Objectives To quantify the current decision uncertainty associated with selecting women who are pregnant or in the puerperium for thromboprophylaxis and to estimate the value of one or more potential future studies that would reduce that uncertainty, while being feasible and acceptable to patients and clinicians. Methods A decision-analytic model was developed which was informed by a systematic review of risk assessment models to predict venous thromboembolism in women who are pregnant or in the puerperium. Expected value of perfect information analysis was used to determine which factors are associated with high decision uncertainty and should be the target of future research. To find out whether future studies would be acceptable and feasible, we held workshops with women who have experienced a blood clot or have been offered blood-thinning drugs and surveyed healthcare professionals. Expected value of sample information analysis was used to estimate the value of potential future research studies. Results The systematic review included 17 studies, comprising 19 unique externally validated risk assessment models and 1 internally validated model. Estimates of sensitivity and specificity were highly variable ranging from 0% to 100% and 5% to 100%, respectively. Most studies had unclear or high risk of bias and applicability concerns. The decision analysis found that there is substantial decision uncertainty regarding the use of risk assessment models to select high-risk women for antepartum prophylaxis and obese postpartum women for postpartum prophylaxis. The main source of decision uncertainty was uncertainty around the effectiveness of thromboprophylaxis for preventing venous thromboembolism in women who are pregnant or in the puerperium. We found that a randomised controlled trial of thromboprophylaxis in obese postpartum women is likely to have substantial value and is more likely to be acceptable and feasible than a trial recruiting women who have had a previous venous thromboembolism. In unselected postpartum women and women following caesarean section, the poor performance of risk assessment models meant that offering prophylaxis based on these models had less favourable cost effectiveness with lower decision uncertainty. Limitations The performance of the risk assessment model for obese postpartum women has not been externally validated. Conclusions Future research should focus on estimating the efficacy of pharmacological thromboprophylaxis in pregnancy and the puerperium, and clinical trials would be more acceptable in women who have not had a previous venous thromboembolism. Study registration This study is registered as PROSPERO CRD42020221094. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR131021) and is published in full in Health Technology Assessment; Vol. 28, No. 9. See the NIHR Funding and Awards website for further award information.

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“…82 More recently Wormer confirmed in his review the cost effectiveness of VTE prophylaxis in patients with severe OHSS, even till the end of first trimester of pregnancy. 85 On the other hand, LMWH has side effects that must be considered to optimize individual therapy. It has shown to be safe in pregnancy for both mother and fetus, since it does not cross the placental barrier.…”

Section: Thromboprophylaxismentioning

confidence: 99%

Ovarian Hyperstimulation: Diagnosis, Prevention, and Management

et al. 2021

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Ovarian hyperstimulation syndrome (OHSS) is a severe complication of controlled ovarian stimulation (COS). Pathogenesis of the disease is based on massive transudation of protein-rich fluid from the vascular compartment into the peritoneal, pleural and pericardial spaces, with a variable picture of clinical manifestations depending on its severity. Nowadays OHSS can easily be avoided by several prevention methods, ranging from identification of high-risk patients, choice of a correct protocol stimulation, trigger with gonadotropin-releasing hormone (GnRH) agonists or, finally, the freeze-all strategy. When OHSS occurs, it can usually be managed as outpatient care. Only if severe/critical cases are diagnosed hospitalization is necessary for appropriate rehydration, monitoring of fluid balance and eventual drainage of ascitic fluid. One of the most dangerous complications of OHSS is venous thromboembolism (VTE). Thromboprophylaxis has shown to be cost effective and widely used, while there are controversies regarding the usage of low dose aspirin (LDA) as a preventive measure.

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Is thromboprophylaxis cost effective in ovarian hyperstimulation syndrome: A systematic review and cost analysis

Cited by 13 publications

References 65 publications

A case report of Ovarian hyperstimulation syndrome and corpus luteum rupture in twin pregnancies with IVF-ET

A case report of Ovarian hyperstimulation syndrome and corpus luteum rupture in twin pregnancies with IVF-ET

Thromboprophylaxis during pregnancy and the puerperium: a systematic review and economic evaluation to estimate the value of future research

Ovarian Hyperstimulation: Diagnosis, Prevention, and Management

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