Epidemiology, natural history, diagnosis, and management of ovarian vein thrombosis: a scoping review

Ovarian vein thrombosis (OVT) is a rare but potentially serious condition. We conducted a scoping review of published data to provide a better understanding of OVT management. MEDLINE and Cochrane databases were searched. Eligibility criterion was original articles including women with OVT until May 2024. Quantitative data were pooled via CMA software. Quality of the primary studies was assessed via the Newcastle‒Ottawa Scale. Out of 1,007 identified records, 19 primary studies including 1,128 patients were selected. Mean age at OVT diagnosis was 37 years old. Frequency of OVT depended on the clinical situation: cancer (37%) and postpartum (0.06%), including cesarean (0.19%), or persistent fever despite antibiotics (23%). Magnetic resonance imaging was associated with the best diagnostic performance, followed by computed tomography. Pulmonary embolism and extension to the iliac vein, inferior vena cava or left renal vein occurred in 6.5%, 5.9%, 10.3% and 9.6% of patients, respectively. Among anticoagulants, low-molecular-height heparin with/without oral anticoagulant was preferred for three to six months. Among the women tested, thrombophilia was present in 18% of the patients. Recanalization, recurrent thrombosis or major bleeding occurred in 70%, 8% and 2% of patients, respectively. Majority of studies had poor evidence. This scoping review provides a comprehensive evaluation of available data. Frequency of OVT depends on the clinical setting. Physicians should be aware of OVT in postpartum women with persistent fever despite the use of antibiotics. Ovarian vein thrombosis belongs to the spectrum of venous thromboembolism and should be considered both in puerperal settings and in cancer patients.