Ovarian Vein Thrombus: Is Treatment Necessary?

Background

Ovarian vein thrombus (OVT) has been described in patients with numerous comorbidities and is often an incidental finding on imaging. Prior studies have failed to draw a consensus regarding the best treatment for OVT. The purpose of this study is to evaluate if patient outcomes change based on treatment and to examine if anticoagulation duration affects resolution of OVT.

Methods

This study utilized a retrospective chart review to identify patients with OVT. Patients who carried any diagnosis containing the words "clot" or "thrombus" from January 2010 to May 2015 in the Penn Medicine system were included in the study. If a patient was identified as having an OVT based on radiologic findings, the following data was extracted from her chart: race, age at diagnosis, date of diagnosis, family history of thrombus, hypercoaguable work up, laterality of OVT, if OVT was occlusive, extension into adjacent veins, history of prior thrombus, context of diagnosis, treatment used, length of treatment, complications, and date of last contact.

Results

Of the 1436 patients identified during the inclusion period, 50 subjects with OVT were identified. The average age at diagnosis was 43.4 years. Fifty-six percent of subjects were African American and 38 percent were Caucasian. Sixty percent of OVT were located within the right gonadal vein, 14 percent were bilateral, and 24 percent were isolated to the left gonadal vein. Thirty eight percent of OVT were occlusive, eight percent extended into adjacent veins, and seven subjects had thrombi identified within alternative locations at the time of OVT diagnosis. Based on presumed etiology of OVT, patients were subdivided into eight categories as follows: active malignancy, peri- partum or post-partum, recent surgery, remote surgery, hypercoaguable state, active infection, incidental finding, and unknown. Eleven subjects received no treatment, one was treated with aspirin alone, three were treated with anticoagulation and antibiotics, and 32 patients were given anticoagulation alone. Three subjects had IVC filters placed at various times after presentation.

Average length of follow up was 23.7 months (1- 108 months). Average length of anticoagulation was 13.2 weeks (3.5- 36 weeks). Two patients developed thrombi following treatment completion. Ten patients had imaging showing resolution of OVT after anticoagulation, while two patients who received no anticoagulation had radiographically confirmed resolution of OVT. Five patients treated with therapeutic anticoagulation exhibited persistent OVT following treatment, while four patients who did not receive anticoagulation had persistent OVT on follow up imaging. No statistically significant difference was identified in complication rate or resolution of OVT when comparing between patients who received treatment and those who did not receive treatment.

Conclusions

Similar to prior studies, we found that most patients had right sided OVT, and most OVT were found in the context of malignancy, pregnancy, the post- partum period, or post- operatively. There was no statistically significant correlation found between treatment and no treatment in terms of overall outcomes for patients diagnosed with OVT. Based on our findings, unless an OVT is symptomatic or septic in nature, an incidentally detected OVT does not necessarily warrant anticoagulation therapy.