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

Abstract

Background: The role of anticoagulation in ovarian vein thrombosis (OVT) is uncertain. We aimed to evaluate safety and efficacy of anticoagulant treatment in OVT patients.

Methods: A systematic search was conducted in MEDLINE, EMBASE, CENTRAL databases, up to April 2024. Eligible studies included randomized controlled trials and observational studies enrolling at least 10 adult patients with objectively diagnosed OVT and treated with any anticoagulants. The protocol was prospectively registered in PROSPERO (CRD42021270883).

Results: We included 17 observational studies (621 anticoagulated, 376 non-anticoagulated OVT patients); 9 studies enrolled mainly pregnancy/puerperium-related OVT. Most patients received heparins alone (45.7%) or proceeded to vitamin K antagonists (39.2%). The average treatment duration was ≤ 3 months in 8 studies (47.1%), > 3 to ≤ 6 months in 6 studies (35.3%), > 6 months in 3 studies (17.6%). In treated patients, mortality rate was 2.43% (95%CI, 0.54-5.41%; I2=53.8%; 12/406 patients; 13 studies); major bleeding 1.27% (95%CI, 0.48-2.38%; I2=2.5%; 7/583 patients; 15 studies); recurrent venous thromboembolism (VTE) 3.49% (95%CI, 1.12-6.95%; I2=63.5%; 22/482 patients; 15 studies); vessel recanalization 89.4% (95%CI, 74.6-98.6%; I2=80.6%; 163/184 patients; 8 studies). The rate of recurrent VTE in untreated patients was 8.65% (95%CI, 2.61-17.35); however, the difference with treated patients was not statistically significant (risk ratio 0.70; 95%CI, 0.36-1.37). At subgroup analyses, the rates of major bleeding and recurrent VTE were 0.80% (95%CI, 0.0-2.17%) and 3.81% (95%CI, 0.42-9.63%) in pregnancy/puerperium-related OVT; 1.12% (95%CI, 0.32-2.34%) and 1.78% (95%CI, 0.62-3.46%) when analysing only full-text studies.

Conclusions: There is paucity of literature regarding OVT. Our results suggest that anticoagulation is associated with low rates of major bleeding and recurrent VTE.