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Safety and efficacy of anticoagulant treatment in patients with ovarian vein thrombosis: A systematic review and meta-analysis

1Faculty of Medicine and Surgery, University of Malta, Msida, Malta, 2Faculty of Medicine and Surgery, University of Malta, Msida, Not Applicable, Malta, 3Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Not Applicable, Malta, 4Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Not Applicable, Malta

Abstract Number: PB0434

Meeting: ISTH 2022 Congress

Theme: Venous Thromboembolism » Visceral Vein Thrombosis

Background: Ovarian vein thrombosis (OVT) is a rare category of venous thromboembolism (VTE). It is usually reported during pregnancy/puerperium, but risk factors also include malignancies, pelvic surgery and local infections. The treatment typically consists of antibiotics and anticoagulants; however, it is debated whether anticoagulation is appropriate for all aetiologies of OVT.

Aims: To evaluate safety and efficacy of anticoagulant treatment for OVT by performing a systematic review of the literature and meta-analysis.

Methods: The protocol was registered a priori in PROSPERO (CRD42021270883). We performed a bibliographic search within the electronic databases MEDLINE, EMBASE and CENTRAL from inception to July 2021. We included randomized control trials and observational studies/case-series enrolling at least 10 adult patients diagnosed with OVT and treated with any anticoagulant drugs. The following outcomes were extracted: mortality, major bleeding and recurrent VTE during anticoagulant treatment, and vessel recanalization. We calculated weighted mean proportions using a random-effects model.

Results: We retrieved 11 observational studies enrolling OVT patients treated with anticoagulants (n=361); 4 studies evaluated also OVT patients who were not anticoagulated (n=286). Six studies included only post-partum OVT, while the remaining included mixed aetiologies.

The most common anticoagulants were warfarin and heparin; average treatment duration ranged from 1 to 9 months. In treated patients, mortality rate was 2.18% (95% CI, 0-10.03%; I2=63.0%; 4/134 patients, 5 studies); major bleeding 0.95% (95% CI, 0-3.60%; I2=0%; 1/129 patients, 2 studies); recurrent VTE 2.10% (95% CI, 0.04-6.16%; I2=4.2%; 2/101, 5 studies); and vessel recanalization 92.8% (95% CI, 74.6-100%; I2=83.2%; 134/149 patients, 6 studies). The rate of recurrent VTE in untreated patients was 9.88% (95% CI, 5.95-14.65%; I2=0%; 18/184 patients, 2 studies).

Conclusion(s): There is a scarcity of literature available on the use of anticoagulation for OVT. Our results suggest that anticoagulant treatment is associated with reduced VTE recurrence and low major bleeding events.

To cite this abstract in AMA style:

Vassallo C, Muscat Baron L, Riva N, Gatt A, Calleja-Agius J. Safety and efficacy of anticoagulant treatment in patients with ovarian vein thrombosis: A systematic review and meta-analysis [abstract]. https://abstracts.isth.org/abstract/safety-and-efficacy-of-anticoagulant-treatment-in-patients-with-ovarian-vein-thrombosis-a-systematic-review-and-meta-analysis/. Accessed September 29, 2023.

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