Postoperative Ovarian Vein Thrombosis and Treatment with Direct Oral Anticoagulant
Shukr G, Gonte MR, Webber VE, Abood JA, Arsanious S, and Eisenstein D. Postoperative Ovarian Vein Thrombosis and Treatment with Direct Oral Anticoagulant. Gynecol Minim Invasive Ther 2023; 12(2):113-115.
Gynecol Minim Invasive Ther
Postoperative ovarian vein thrombosis (OVT) is a rare complication following hysterectomy. Due to its ambiguous presentation, most frequently presenting as a fever with no known source and lower quadrant abdominal pain, OVTs are commonly diagnosed incidentally on computed tomography as a low-attenuation thrombus in place of the ovarian vein. The cornerstones of OVT treatment include anticoagulation and antibiotic therapy; however, there are no current guidelines to inform provider decision-making regarding specific anticoagulant agents, dosing, or length of therapy. We present a patient with a history of deep-vein thrombosis, who presented to the emergency department with OVT following a laparoscopic hysterectomy. She was treated with apixaban, a direct oral anticoagulant (DOAC), and experienced repeated episodes of vaginal bleeding and hematoma expansion. We present this case to instill a high index of suspicion for OVT after laparoscopic hysterectomy, and to discuss the role of DOACs in patients with thromboembolic disease and concurrent bleeding.