Findings of 7 studies evaluating management strategies of postpartum OVT
| Reference . | Study design . | N . | Treatment (n) . | Anticoagulant duration . | Resolution of fever, n/N (%) . | Recurrent VTE, n/N (%) . | Bleeding, n/N (%) . |
|---|---|---|---|---|---|---|---|
| 2 | Retrospective cohort study | 60 | Anticoagulation alone (24) | Median, 3 mo (3-6 mo) | NR | 0/24 (0) | NR |
| Antibiotics and anticoagulation (36) | NR | 0/36 (0) | NR | ||||
| 3 | Prospective cohort study | 13 | LMWH* | 3 mo | NR | 0/13 (0) | NR |
| 7 | Randomized controlled trial | 14 | Antibiotics alone (8) | — | 8/8 (100) (140 ± 39 h) | 0/8 (0) | NR |
| Antibiotics and heparin (6) | 0-6 d | 5/5 (100) (134 ± 65 h) | 0/5 (0) | NR | |||
| 1 | Retrospective cohort study | 22 | Heparin/VKA (22)† | 1-60 mo | 0/18 (0)‡ | 0/22 (0) | NR |
| 9 | Retrospective case series | 10 | Antibiotics and anticoagulation (36) | 10-60 d | 9/10 (90) | 0/36 (0) | NR |
| Operative intervention (adnexal excision) (1) | — | 1/1 (100) | 0/1 (0) | NR | |||
| 13 | Retrospective cohort study | 11 | Initial antibiotics alone (11) | — | 0/11 (0) | 1/11 (9)‡ | 0/11 (0) |
| Heparin/VKA (11) | 7 d to 3 mo | 11/11 (100) | 1/11 (9)‡, extension of OVT | 1/11 (9)‡ | |||
| 8 | Retrospective case series | 6 | Initial antibiotics alone (5) | — | 0/5 (0) | 1/6 (16.6)§ | NR |
| Antibiotics and heparin (4) | NR | 2/4 (50) | 0/6 (0) | NR | |||
| Operative intervention (vein ligation and/or oophorectomy/hysterectomy) (3) | — | 2/3 (67) | 1/6 (16.6), PE-related death intraoperatively§ | NR | |||
| 11 | Retrospective case series | 6 | Initial antibiotics alone (4) | — | 0/4 (0) | 0/6 (0) | NR |
| Antibiotics and heparin/VKA (4)|| | NR | 3/4 (75) | 0/6 (0) | NR | |||
| Operative intervention (vein ligation/resection and/or hysterectomy) (6) | — | 4/6 (67) | 1/6 (16.6), possible PE postoperatively | NR |
| Reference . | Study design . | N . | Treatment (n) . | Anticoagulant duration . | Resolution of fever, n/N (%) . | Recurrent VTE, n/N (%) . | Bleeding, n/N (%) . |
|---|---|---|---|---|---|---|---|
| 2 | Retrospective cohort study | 60 | Anticoagulation alone (24) | Median, 3 mo (3-6 mo) | NR | 0/24 (0) | NR |
| Antibiotics and anticoagulation (36) | NR | 0/36 (0) | NR | ||||
| 3 | Prospective cohort study | 13 | LMWH* | 3 mo | NR | 0/13 (0) | NR |
| 7 | Randomized controlled trial | 14 | Antibiotics alone (8) | — | 8/8 (100) (140 ± 39 h) | 0/8 (0) | NR |
| Antibiotics and heparin (6) | 0-6 d | 5/5 (100) (134 ± 65 h) | 0/5 (0) | NR | |||
| 1 | Retrospective cohort study | 22 | Heparin/VKA (22)† | 1-60 mo | 0/18 (0)‡ | 0/22 (0) | NR |
| 9 | Retrospective case series | 10 | Antibiotics and anticoagulation (36) | 10-60 d | 9/10 (90) | 0/36 (0) | NR |
| Operative intervention (adnexal excision) (1) | — | 1/1 (100) | 0/1 (0) | NR | |||
| 13 | Retrospective cohort study | 11 | Initial antibiotics alone (11) | — | 0/11 (0) | 1/11 (9)‡ | 0/11 (0) |
| Heparin/VKA (11) | 7 d to 3 mo | 11/11 (100) | 1/11 (9)‡, extension of OVT | 1/11 (9)‡ | |||
| 8 | Retrospective case series | 6 | Initial antibiotics alone (5) | — | 0/5 (0) | 1/6 (16.6)§ | NR |
| Antibiotics and heparin (4) | NR | 2/4 (50) | 0/6 (0) | NR | |||
| Operative intervention (vein ligation and/or oophorectomy/hysterectomy) (3) | — | 2/3 (67) | 1/6 (16.6), PE-related death intraoperatively§ | NR | |||
| 11 | Retrospective case series | 6 | Initial antibiotics alone (4) | — | 0/4 (0) | 0/6 (0) | NR |
| Antibiotics and heparin/VKA (4)|| | NR | 3/4 (75) | 0/6 (0) | NR | |||
| Operative intervention (vein ligation/resection and/or hysterectomy) (6) | — | 4/6 (67) | 1/6 (16.6), possible PE postoperatively | NR |
VTE includes recurrent ovarian vein thrombosis, deep vein thrombosis or pulmonary embolism.
LMWH, low-molecular-weight heparin; NR: not reported; PE: pulmonary embolism; VKA: vitamin K antagonist.
The LMWH regimen consisted of enoxaparin 1 mg/kg subcutaneously twice daily for 2 weeks, followed by 1 mg subcutaneously daily for 3 mo.
Concomitant antibiotic use was not reported, but it was likely given in a subset of cases where fever was present.
Extension of left OVT and new right OVT despite treatment with 8 d of antibiotics and 6 d of heparin. The bleed reported was a subcutaneous hemorrhage in a different patient.
In combination with antibiotics alone (2 cases) or antibiotics and heparin (1 case). A patient with PE had initial antibiotics alone followed by surgery.
Received antibiotics and anticoagulation postoperatively after diagnostic and treatment laparotomy. One patient was treated with dicumarol postoperatively without heparin therapy.