Key result
Expert consensus suggests women with prior venous thrombosis undergoing assisted reproductive therapy use low-molecular-weight heparin from ovarian stimulation through 6 weeks postpartum.
Why the study?
Assisted reproductive therapy increases venous thrombosis risk, but literature and international guidelines on thromboprophylaxis for women with a history of venous thrombosis undergoing ART are lacking.
Does thromboprophylaxis prevent recurrent thrombosis in women with prior thromboembolic disease undergoing assisted reproductive therapy?
Does thromboprophylaxis prevent recurrent thrombosis in women with prior thromboembolic disease undergoing assisted reproductive therapy?
In the absence of international guidelines, expert consensus recommends targeted thromboprophylaxis (LMWH or aspirin) and ART adjustments for women with prior thromboembolic disease undergoing assisted reproductive therapy.
Expert opinion suggests LMWH thromboprophylaxis from ovulation in prior VT; leaves open need for prospective trials to guide practice.
Assisted reproductive therapy (ART) increases the risk of venous thrombosis (VT) by 2- to 4-fold, whereas pregnancy increases the risk by 5- to 10-fold. Women with a history of VT undergoing ART are often suggested thromboprophylaxis. The literature is scarce and international guidelines are lacking. We made a review of the literature and base our suggestions primarily on expert opinions. We suggest women with a prior VT to use low-molecular-weight heparin as thromboprophylaxis starting from ovarian stimulation, throughout pregnancy, and 6 weeks postpartum. Assessment of VT risk should be done prior to ART. Adjustment of treatment to minimize the thrombotic risk, such as preventing ovarian hyperstimulation syndrome, single-embryo transfer, cryopreservation, and transfer of frozen embryos instead of fresh embryo in high-risk women, is suggested. Women with previous arterial thrombosis should continue aspirin during ART treatment, pregnancy, and postpartum.
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Jacobsen et al. (2021) conducted a review in Prior thromboembolic disease undergoing assisted reproductive therapy. Thromboprophylaxis (low-molecular-weight heparin or aspirin) was evaluated. Expert consensus suggests women with prior venous thrombosis undergoing assisted reproductive therapy use low-molecular-weight heparin from ovarian stimulation through 6 weeks postpartum.
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