McGowan B M C, Kay L A, Perry D J
Haemophilia and Haemostasis Unit, Department of Haematology, Royal Free and University College Medical School, London, England.
Am J Hematol. 2003 Aug;73(4):276-8. doi: 10.1002/ajh.10367.
Thrombosis of the internal jugular vein is a rare event but one that can have serious consequences. Most cases reported in the literature have occurred in patients with indwelling central venous catheters, in association with head and neck sepsis, or in hypercoagulable states. However, a small number of cases have been associated with in vitro fertilization and more often with the ovarian hyperstimulation syndrome (OHSS). We report the case of a 30-year-old woman heterozygous for both the prothrombin 3' UTR mutation and for the factor V Leiden mutation who presented with a proximal deep vein thrombosis following in vitro fertilization. She subsequently developed an internal jugular vein thrombosis extending into the subclavian and axillary vein despite therapeutic anticoagulation with a low molecular weight heparin. Thromboembolic events can occur in the absence of other clinical features of OHSS, especially in patients with underlying prothrombotic abnormalities. Neck pain and swelling in a pregnant woman, especially one that has undergone in vitro fertilization, should be taken seriously and investigated with duplex scanning and/or MRI. Women with a personal or family history of thrombosis undergoing in vitro fertilization should be made fully aware of the potential thrombotic risks and should be considered for a thrombophilia screen.
颈内静脉血栓形成是一种罕见事件，但可能会产生严重后果。文献报道的大多数病例发生在留置中心静脉导管的患者中，与头颈部脓毒症相关，或处于高凝状态。然而，少数病例与体外受精有关，且更常与卵巢过度刺激综合征（OHSS）相关。我们报告了一例30岁女性，她同时携带凝血酶原3'UTR突变和因子V莱顿突变的杂合子，在体外受精后出现近端深静脉血栓形成。尽管使用低分子肝素进行了治疗性抗凝，她随后仍发生了颈内静脉血栓形成，并延伸至锁骨下静脉和腋静脉。血栓栓塞事件可在无OHSS其他临床特征的情况下发生，尤其是在有潜在血栓前异常的患者中。孕妇出现颈部疼痛和肿胀，尤其是接受过体外受精的孕妇，应予以重视，并通过双功扫描和/或MRI进行检查。有个人或家族血栓形成病史且接受体外受精的女性应充分了解潜在的血栓形成风险，并应考虑进行血栓形成倾向筛查。
