[Changes in coagulability and fibrinolytic activity in the patients with ovarian hyperstimulation syndrome]

Ovarian hyperstimulation syndrome (OHSS) is occasionally seen following hMG-hCG treatment in combination with a GnRH agonist. Increased coagulability and decreased renal perfusion may be life threatening in some severe cases. In order to evaluate coagulo-fibrinolytic activity, several related factors in the general circulation were examined for approximately 2 weeks after admission in 11 patients with severe OHSS. The results are as follows. 1. Fibrinopeptide A (FPA) was increased during the initial stage of OHSS followed by a gradual decrease. However, the level remained slightly higher than normal for 2 weeks after the onset of severe OHSS. 2. Fibrinopeptide B beta 15-42 (FPB beta 15-42) showed grossly similar patterns to those of FPA. 3. D-dimer levels were constantly higher than normal from the initial to the late stages of OHSS. 4. Thrombin-Antithrombin III complex (TAT) was markedly increased on the days of admission followed by a gradual decrease during the following week. 5. Antithrombin III (ATIII), plasminogen and alpha 2 plasmin inhibitor (alpha 2PI) showed only minimal decreasing patterns throughout blood samplings. 6. Increases in FPA, FPB beta 15-42 and D-dimer were greater in the cases with severe hemoconcentrations. Our present data suggest that severe OHSS brings on hypercoagulability resulting in microthrombosis. In order to avoid development of coagulopathy, prophylactic treatment should be considered for patients with OHSS.