Venous Thromboembolism in Women Undergoing Assisted Reproductive Technologies: Data from the RIETE Registry

Grandone, Elvira; Micco, Pier Paolo Di; Villani, Michela; Colaizzo, Donatella; Fernández‐Capitán, Carmen; Toro, J. del; Rosa, Vladimir; Bura-Rivière, A.; Quéré, I.; Blanco-Molina, Ángeles; Margaglione, Maurizio; Monréal, Manuel

doi:10.1055/s-0038-1673402

Cited by 56 publications

(42 citation statements)

References 15 publications

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“…36 Recently, Grandone et al reported data from the Registro Informatizado de Enfermedad TromboEmbolica (RIETE) registry up to October 2016. 37 A total of 41 (0.6%) out of 6,718 women with VTE suffered from an ART-related event. VTE was recorded in 20 successful and 21 unsuccessful ART cycles.…”

Section: Assisted Reproductive Technologiesmentioning

confidence: 99%

Pulmonary Thrombosis: A Clinical Pathological Entity Distinct from Pulmonary Embolism?

Marongiu

Mameli

2019

Semin Thromb Hemost

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Since Virchow's autopsy studies in the mid-1800s, it has generally been believed that pulmonary embolism (PE) originated from the embolization of fibrin fragments from a deep venous thrombosis (DVT). However, a DVT is often not found in patients with PE (up to 50% of cases). Could fibrin form in the pulmonary vessels without coming from the periphery? In this review, the authors will try to support the hypothesis that a pulmonary thrombosis (PT) may develop. They will do so through different clinical models related to some pathological conditions such as pneumonia, chronic obstructive pulmonary disease (COPD), and asthma, all of which show a close relationship between local inflammation and activation of blood coagulation, two defensive systems that may lead to fibrin deposition in the lungs, thus recognizing the possibility that PT may be a newly recognized entity. An increased risk for PE has been demonstrated in these conditions. Sickle cell disease and assisted reproductive technologies are other very different conditions in which an increased risk for PE has been found. Gaucher's disease is a rare hereditary condition in which the hemostatic system could have a role in the pathogenesis of pulmonary hypertension, which complicates the course of the disease. In particular, the increased risk for PT, common to all these conditions, deserves attention when a patient presents with sudden dyspnea, an unexpected COPD exacerbation, or severe sudden asthmatic dyspnea. As a consequence, prediction scores for venous thromboembolism could be revised.

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Section: Assisted Reproductive Technologiesmentioning

confidence: 99%

Pulmonary Thrombosis: A Clinical Pathological Entity Distinct from Pulmonary Embolism?

Marongiu

Mameli

2019

Semin Thromb Hemost

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“…[49][50][51] In the large REITE Registry, the OR for developing VTE in women undergoing ART without HCG (OR, 4.13; 95% confidence interval [CI], 1.4-12.4) was comparable to the VTE risk in contraceptive users (OR, 2.96; 95% CI, 1.95-4.5) and in the puerperium (OR, 1.96; 95% CI, 1.16-3.3). 52 Among women with thrombophilia, it has been well established that exogenous hormones constitute the major risk for thrombosis. The risk of thrombosis among those undergoing non-HCG ART is not different from the general population.…”

Section: The Hematologist's Viewmentioning

confidence: 99%

Case-based discussion on the implications of exogenous estrogens in hemostasis and thrombosis: the hematologist’s view

Ragni

2019

Hematology

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In the childbearing years, hormonal therapy or hormonal changes in the menstrual cycle or the puerperium may be complicated by bleeding or thrombosis; however, among women with congenital disorders of hemostasis and thrombosis, the risk of bleeding or thrombosis may be increased. In women with congenital bleeding disorders, heavy menstrual bleeding is the most common bleeding symptom, and postpartum hemorrhage occurs despite treatment. Given the limitations of current therapy and the associated medical and psychological burden in women with bleeding disorders, better treatment approaches are needed to improve health outcomes and quality of life. In women with congenital thrombotic disorders, thromboembolism may complicate exogenous hormonal therapy and endogenous hormonal change during pregnancy and procedures, but risk differs by type of thrombophilia, procedure, time at risk, and thrombosis risk factors, all of which affect management. In this article, I shall consider a case-based discussion of current issues in women with congenital bleeding and clotting disorders, including heavy menstrual bleeding in a woman with VWD, postpartum hemorrhage risk in VWD, and thrombosis risk with oocyte retrieval in a woman with factor V Leiden and past thromboembolism. The goals are to review bleeding or thrombosis risk in these cases, current data, limitations of current treatment guidelines, and areas for future study.

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“…Embryo transfer In women who undergo ART cycles, the risk of thrombosis is increased in both successful and unsuccessful cycles. 21 Studies using the Swedish medical birth register have found that, in successful pregnancies, women who undergo in vitro fertilization have an increased risk of venous thromboembolism (VTE) during pregnancy of 4-to 5-fold compared with spontaneous conceptions, 22,23 particularly during the first trimester, with an absolute risk of VTE during the first trimester of 0.2%. 22 This is compared with the absolute risk of VTE during the entire gestation of spontaneously conceived pregnancies of 0.05% to 0.2%.…”

Section: The Obstetrician's Viewmentioning

confidence: 99%

Case-based discussion on the implications of exogenous estrogens in hemostasis and thrombosis: the obstetrician’s view

James

2019

Hematology

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This is the obstetrician’s view on 3 different clinical scenarios involving bleeding and thrombotic disorders. In the first scenario, an 18 year old with a history of heavy menstrual bleeding since menarche presents with abdominal pain and ultrasound findings suggestive of a hemorrhagic ovarian cyst. The association with an underlying bleeding disorder is recognized. The goals of management, which are controlling hemorrhage and preserving fertility, are stated. Ovarian suppression, the most effective method to prevent recurrent hemorrhagic ovarian cysts, is outlined. Long-term management of heavy menstrual bleeding with hormonal contraception is described. In the second scenario, the same patient returns 5 years later for a preconception visit. The potential risks to an unborn baby with von Willebrand disease (VWD) are addressed. The natural rise in von Willebrand factor (VWF) during pregnancy is discussed, but the fact that women with VWD do not achieve the same VWF levels as women without VWD is emphasized and the implications are presented. In anticipation of pregnancy, the need for nonhormonal management of heavy menstrual bleeding and hemorrhagic ovarian cysts is mentioned. In the third and final scenario, the patient’s cousin with factor V Leiden seeks consultation regarding the risks of thrombosis with in vitro fertilization. The steps of assisted reproductive technology are described. The strategies to prevent venous thromboembolism by preventing ovarian hyperstimulation and reducing the likelihood of multiple gestation are detailed.

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Venous Thromboembolism in Women Undergoing Assisted Reproductive Technologies: Data from the RIETE Registry

Cited by 56 publications

References 15 publications

Pulmonary Thrombosis: A Clinical Pathological Entity Distinct from Pulmonary Embolism?

Pulmonary Thrombosis: A Clinical Pathological Entity Distinct from Pulmonary Embolism?

Case-based discussion on the implications of exogenous estrogens in hemostasis and thrombosis: the hematologist’s view

Case-based discussion on the implications of exogenous estrogens in hemostasis and thrombosis: the obstetrician’s view

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