Lenz Charles J, Wysokinski Waldemar E, Henkin Stanislav, Cohoon Kevin P, Casanegra Ana, Simmons Benjamin S, Saadiq Rayya A, Daniels Paul R, Wysokinska Ewa M, Bjarnason Haraldur, McBane Robert D
Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota; and Duke Medical Center, Durham, North Carolina.
Obstet Gynecol. 2017 Nov;130(5):1127-1135. doi: 10.1097/AOG.0000000000002319.
To identify the risk of venous thromboembolism recurrence, major bleeding, and mortality in patients with ovarian vein thrombosis so as to better define optimal treatment strategies.
Patients with ovarian vein thrombosis (1990-2015) and age- and gender-matched patients with contemporary leg deep vein thrombosis (DVT) were assessed for differences in etiology, venous thromboembolism recurrence, and survival in a case-control study.
Over the timeframe of this study, only 219 ovarian vein thrombosis cases were identified compared with 13,417 leg DVTs. Median duration of follow-up was 1.23 years (interquartile range 0.25-4.14). Pulmonary embolism was identified at presentation in 6% of patients with ovarian vein thrombosis and 16% of those with DVT (P=.001). Frequent causes of ovarian vein thrombosis included cancer, hormonal stimulation, surgery, and hospitalization. Cancer was twofold more frequent in patients with ovarian vein thrombosis (44% compared with 21%; P<.01). Despite being less frequently treated with anticoagulation (ovarian vein thrombosis 54% compared with DVT 98%, P<.001), venous thromboembolism recurrence rates were similar between groups (ovarian vein thrombosis 2.3 compared with DVT 1.8 per 100 patient-years, P=.49). A personal history of venous thromboembolism and preceding surgery was found to be an independent risk factor for venous thromboembolism recurrence among those treated with anticoagulation (hazard ratio 6.7, P=.04 and hazard ratio 13.6, P=.03, respectively). There was no significant difference in overall survival.
Ovarian vein thrombosis is a rare thrombotic condition with an incidence 60-fold lower compared with leg DVT in our institution. The striking association with cancer adversely affects overall survival rates in patients with ovarian vein thrombosis. Venous thromboembolism recurrence rates argue for anticoagulation with a direct oral anticoagulant or vitamin K antagonist, particularly in those with a history of venous thromboembolism.
确定卵巢静脉血栓形成患者静脉血栓栓塞复发、大出血和死亡的风险，以便更好地确定最佳治疗策略。
在一项病例对照研究中，对1990 - 2015年患有卵巢静脉血栓形成的患者以及年龄和性别匹配的当代下肢深静脉血栓形成（DVT）患者的病因、静脉血栓栓塞复发和生存率差异进行评估。
在本研究期间，仅识别出219例卵巢静脉血栓形成病例，而下肢DVT病例有13417例。中位随访时间为1.23年（四分位间距0.25 - 4.14）。6%的卵巢静脉血栓形成患者和16%的DVT患者在就诊时被诊断为肺栓塞（P = 0.001）。卵巢静脉血栓形成的常见原因包括癌症、激素刺激、手术和住院。卵巢静脉血栓形成患者中癌症的发生率是DVT患者的两倍（44%对21%；P < 0.01）。尽管接受抗凝治疗的频率较低（卵巢静脉血栓形成患者为54%，DVT患者为98%，P < 0.001），但两组之间静脉血栓栓塞复发率相似（卵巢静脉血栓形成患者每100患者年为2.3例，DVT患者为1.8例，P = 0.49）。在接受抗凝治疗的患者中，静脉血栓栓塞复发的独立危险因素是有静脉血栓栓塞个人史和既往手术史（风险比分别为6.7，P = 0.04和风险比13.6，P = 0.03）。总体生存率无显著差异。
卵巢静脉血栓形成是一种罕见的血栓形成疾病，在我们机构中其发病率比下肢DVT低60倍。与癌症的显著关联对卵巢静脉血栓形成患者的总体生存率产生不利影响。静脉血栓栓塞复发率表明应使用直接口服抗凝剂或维生素K拮抗剂进行抗凝治疗，特别是在有静脉血栓栓塞病史的患者中。
