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

Elvira Grandone; Pier Paolo Di Micco; Michela Villani; Donatella Colaizzo; Carmen Fernández-Capitán; Jorge Del Toro; Vladimir Rosa; Alessandra Bura-Riviere; Isabelle Quere; Ángeles Blanco-Molina; Maurizio Margaglione; Manuel Monreal; for the RIETE Investigators

doi:10.1055/s-0038-1673402

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2018; 118(11): 1962-1968
DOI: 10.1055/s-0038-1673402

Stroke, Systemic or Venous Thromboembolism

Georg Thieme Verlag KG Stuttgart · New York

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

Authors

Elvira Grandone

¹Thrombosis and Haemostasis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy
Pier Paolo Di Micco

²Department of Internal Medicine, Ospedale Fatebenefratelli, Napoli, Italy
Michela Villani

¹Thrombosis and Haemostasis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy
Donatella Colaizzo

¹Thrombosis and Haemostasis Unit, I.R.C.C.S. Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy
Carmen Fernández-Capitán

³Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Jorge Del Toro

⁴Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
Vladimir Rosa

⁵Department of Internal Medicine, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
Alessandra Bura-Riviere

⁶Department of Vascular Medicine, Hôpital de Rangueil, Toulouse, France
Isabelle Quere

⁷Department of Vascular Medicine, Hôpital Saint Eloi, Montpellier, France
Ángeles Blanco-Molina

⁸Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain
Maurizio Margaglione

⁹Department of Medical Genetics, University of Foggia, Foggia, Italy
Manuel Monreal

¹⁰Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Barcelona, Spain

for the RIETE Investigators

Abstract

Venous thromboembolism (VTE) during or after assisted reproductive technologies (ART) is predicted to rise due to the increased number of women undergoing this technique. We present data collected in the RIETE registry up to October 2016. Overall, 41 (0.6%) out of 6,718 women of childbearing age with VTE had an ART-related event. Most of them underwent autologous ART cycles; 23 had isolated deep vein thrombosis (DVT) (56.1%), 12 isolated pulmonary embolism (PE) (29.3%) and 6 simultaneous occurrence of both the events (14.6%). VTE occurred in 20 successful and 21 unsuccessful (i.e. not resulting in a clinical pregnancy) ART cycles. No recurrence was observed at 90 days. Logistic regression showed that isolated PE was significantly more frequent than DVT alone or combined with PE in unsuccessful in vitro fertilization (IVF) (odds ratio [OR]: 4.13, 95% confidence interval [CI]: 1.4–12.4), as well as in contraceptive users (OR: 2.96, 95% CI: 1.95–4.5) and in puerperium (OR: 1.96, 95% CI: 1.16–3.3). After grouping isolated PE and DVT + PE, we found that PE was significantly more frequent in women with unsuccessful IVF and higher body mass index (OR: 5.0, 95% CI: 1.2–20.7 and OR: 1.0, 95%CI: 1.0–1.1, respectively). These data document a higher risk of PE in unsuccessful cycles than in successful ones. The risk is higher than that observed during pregnancy, puerperium and contraception.

Keywords

assisted reproductive technologies - venous thromboembolism - pregnancy

Volltext

Referenzen

References
1 Calhaz-Jorge C, de Geyter C, Kupka MS. , et al; European IVF-Monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology in Europe, 2012: results generated from European registers by ESHRE. Hum Reprod 2016; 31 (08) 1638-1652
2 Chan WS, Dixon ME. The “ART” of thromboembolism: a review of assisted reproductive technology and thromboembolic complications. Thromb Res 2008; 121 (06) 713-726
3 Grandone E, Colaizzo D, Vergura P. , et al. Age and homocysteine plasma levels are risk factors for thrombotic complications after ovarian stimulation. Hum Reprod 2004; 19 (08) 1796-1799
4 Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review. Hum Reprod Update 2002; 8 (06) 559-577
5 Klemetti R, Sevón T, Gissler M, Hemminki E. Complications of IVF and ovulation induction. Hum Reprod 2005; 20 (12) 3293-3300
6 Chan WS. The ‘ART’ of thrombosis: a review of arterial and venous thrombosis in assisted reproductive technology. Curr Opin Obstet Gynecol 2009; 21 (03) 207-218
7 Rova K, Passmark H, Lindqvist PG. Venous thromboembolism in relation to in vitro fertilization: an approach to determining the incidence and increase in risk in successful cycles. Fertil Steril 2012; 97 (01) 95-100
8 Di Nisio M, Rutjes AW, Ferrante N, Tiboni GM, Cuccurullo F, Porreca E. Thrombophilia and outcomes of assisted reproduction technologies: a systematic review and meta-analysis. Blood 2011; 118 (10) 2670-2678
9 Mancuso A, De Vivo A, Fanara G, Di Leo R, Toscano A. Upper body venous thrombosis associated with ovarian stimulation: case report and review of the literature. Clin Exp Obstet Gynecol 2005; 32 (03) 149-154
10 Al-Shawaf T, Grudzinskas JG. Prevention and treatment of ovarian hyperstimulation syndrome. Best Pract Res Clin Obstet Gynaecol 2003; 17 (02) 249-261
11 Blanco-Molina A, Trujillo-Santos J, Criado J. , et al; RIETE Investigators. Venous thromboembolism during pregnancy or postpartum: findings from the RIETE Registry. Thromb Haemost 2007; 97 (02) 186-190
12 Henriksson P, Westerlund E, Wallén H, Brandt L, Hovatta O, Ekbom A. Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study. BMJ 2013; 346: e8632
13 Villani M, Favuzzi G, Totaro P. , et al. Venous thromboembolism in assisted reproductive technologies: comparison between unsuccessful versus successful cycles in an Italian cohort. J Thromb Thrombolysis 2018; 45 (02) 234-239
14 Czihal M, Hoffmann U. Upper extremity deep venous thrombosis. Vasc Med 2011; 16 (03) 191-202
15 Hansen AT, Kesmodel US, Juul S, Hvas AM. Increased venous thrombosis incidence in pregnancies after in vitro fertilization. Hum Reprod 2014; 29 (03) 611-617
16 van Langevelde K, Flinterman LE, van Hylckama Vlieg A, Rosendaal FR, Cannegieter SC. Broadening the factor V Leiden paradox: pulmonary embolism and deep-vein thrombosis as 2 sides of the spectrum. Blood 2012; 120 (05) 933-946

Zusatzmaterial

Supplementary Material Appendix A (PDF)