Internal jugular vein thrombosis following in-vitro fertilization in a woman with protein S deficiency and heterozygosity for the prothrombin 3′ UTR mutation, despite anticoagulation with heparin

Abstract

We report the case of a 31-year-old woman with protein S deficiency and heterozygosity for the prothrombin 3' UTR mutation who developed an internal jugular vein thrombosis despite therapeutic anticoagulation with a low molecular weight heparin, following in-vitro fertilization. This case indicates that the stimulus to thrombosis in such women is intense and can occur despite apparent therapeutic anticoagulation. Close attention should, therefore, be paid to any women with a personal or family history of thrombosis and the potential thrombotic risks associated with assisted conception must be discussed.

The ‘ART’ of thrombosis: a review of arterial and venous thrombosis in assisted reproductive technology

“…Other identifiable risk factors (such as malignancy and use of central venous catheters) were reported in only three patients [36,59,63], all associated with venous thrombosis. For all but four patients (5%) [36,43,54,57], no thromboprophylaxis was administered during the treatment cycle; in 12 (13%) patients, at least low-dose thromboprophylaxis was given when OHSS developed and while the patients were hospitalized [23,37,[41][42][43]53,59,[79][80][81]. In six patients [51,55,57,62,63,81] with venous thromboses and in one patient with arterial thrombosis [72], progression of thrombosis occurred despite administration of anticoagulation; the overall risk of progression is 7.5%.…”

Thrombosis post ovarian hyperstimulation

“…Hereditary hypercoagulable states also increase the risk for thrombosis. Internal jugular vein thrombosis associated with OHSS has been described in association with factor V Leiden mutation (9), heterozygosity for both factor V Leiden mutation and prothrombin III 0 UTR mutation (10), activated protein C resistance (11,12), antithrombin III deficiency (13), and both protein S deficiency and heterozygosity for prothrombin III 0 UTR mutation (14). In addition to OHSS, our patient also had a hereditary hypercoagulable state, a positive lupus anticoagulant as another risk factor.…”

Middle cerebral artery thrombosis after IVF and ovarian hyperstimulation: a case report

“…It was reported that other predisposing factors existed which increased the risk of thrombus, such as antithrombin III (11), activated protein C (12), protein S deficiency (13), and factor V mutation (14). In the present case, more specific thrombosis risk factors, such as protein C, protein S, Leiden V factor, and antithrombin III deficiencies, were not checked.…”