Thromboprophylaxis in women undergoing gynecological surgery or assisted reproductive techniques: new advances and challenges

Abstract

Venous thromboembolism (VTE) affects 0.1-0.3% people each year. The risk of VTE following gynecological surgery and invasive procedures is well established and presents one of the major challenges in gynecological practice. Moreover, commonly use assisted reproductive techniques (ART) are reported to increase the risk of VTE. Despite continued efforts to reduce its incidence, postoperative VTE remains the second most common perioperative complication and the third most common cause of mortality.Several practice guidelines have been developed regarding prophylaxis and treatment of VTE. However, there is a large inconsistency between the recommendations and the medical practice in various centers. Moreover, prophylaxis in gynecological patients and women undergoing ART should be chosen individually for the patient, taking into account the possible risk factors for VTE and perioperative bleeding complications. Until recently, the percentage of women, who have not received anticoagulant prophylaxis or administrated it inadequately may reach 50%.This paper presents the current recommendations regarding thromboprophylaxis in women undergoing gynecological surgery or assisted reproductive techniques and addresses challenging practical issues in this field.

Meta-Analysis of VTE Risk: Ovarian Cancer Patients by Stage, Histology, Cytoreduction, and Ascites at Diagnosis

“…The grade, aggressiveness, and cellular-level mechanisms associated with specific histological types of ovarian cancer are thought to influence VTE risk through the upregulation of tissue factor, VIIa, biomarkers, and macrophages [ 9 , 15 , 18 , 19 , 23 , 24 ]. Further, the aggressive surgical and chemotherapy treatment of ovarian cancer likely causes high thrombosis rates [ 16 , 19 , 25 – 27 ]. Complete cytoreductive surgery, the recommended surgical treatment for ovarian cancer, requires extensive surgical steps involving lymph node sampling, tumor removal, and organ removal [ 28 , 29 ].…”

Follicular aspiration versus coasting for ovarian hyper-stimulation syndrome prevention

“…However, regardless of the cause, gynaecologists and physicians should be aware of OHSS because of its high morbidity and potential mortality. 1 , 2 While it is impossible to avoid OHSS completely, patients who are at risk should be identified early since preventive measures taken during the early stages of COS can improve outcome. 15 , 16 …”