Abstract Number: PB0005
Meeting: ISTH 2021 Congress
Follitropin Beta (Follistim) is a recombinant human follicle stimulating hormone (rhFSH) used to stimulate ovarian follicular growth in women. Both venous and arterial thrombosis have been reported in association with ovarian stimulation with and without ovarian hyperstimulation syndrome (OHSS).
By sharing the presentation of a rare yet serious condition of ST-segment elevation myocardial infarction (STEMI) associated with ovarian stimulation, we aim to emphasize the possible risk of major thromboembolic events associated with exogenous gonadotropin administration for ovarian induction.
We present a rare association between ovarian stimulation with the use of rhFSH and STEMI, which to our knowledge, is the first case of STEMI in the absence of OHSS associated with ovarian stimulation to be reported.
A 47-year-old athletic female without any risk factors for cardiovascular disease or predisposing conditions for hypercoagulable state, presented to the emergency room with new onset chest pain. 12-lead ECG showed ST-segment elevation in the anterolateral leads with elevated serum troponin levels. Percutaneous coronary intervention (PCI) showed 100% occlusion of the mid left anterior descending artery (LAD). Two stents were successfully deployed to the LAD.
Conclusions: As our patient with no symptoms of OHSS, cardiovascular risk, or underlying hypercoagulable conditions presented with ACS associated with rhFSH use, the risk of major thromboembolic events associated with exogenous gonadotropin administration for ovarian induction is emphasized. Clinicians should be prompted to evaluate for cardiovascular risk and discuss the risk of thromboembolic events with patients when considering ovarian stimulation. Further analysis of serum estrogen levels in patients developing thromboembolic events with ovarian stimulation may provide guidance into risk stratification of thromboembolic events and the need for prophylactic anticoagulation accordingly. As there are no current guidelines on prophylactic anticoagulation during ovarian stimulation, further studies are needed to provide guidance in anticoagulation therapies and risk stratification for thromboembolic events in these patients.
To cite this abstract in AMA style:Kim KY, Gerais Y, Prasad A, Kim NH, Sun C, Hussein S, Thapa P, Ramadurai R. A Rare Presentation of ST-segment Elevation Myocardial Infarction Associated with Ovarian Stimulation in the Absence of Ovarian Hyperstimulation Syndrome [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/a-rare-presentation-of-st-segment-elevation-myocardial-infarction-associated-with-ovarian-stimulation-in-the-absence-of-ovarian-hyperstimulation-syndrome/. Accessed January 24, 2022.
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