Reinfusion of peritoneal fluid elevates the level of plasma D-dimer in patients with early-onset ovarian hyperstimulation syndrome

Shiori Kumazawa; Kazuki Saito; Nanako Hashido; Rinko Ibi; Tomonori Ishikawa; Akira Wakabayashi; Naoyuki Miyasaka

doi:10.1002/rmb2.12563

Reinfusion of peritoneal fluid elevates the level of plasma D-dimer in patients with early-onset ovarian hyperstimulation syndrome

Reprod Med Biol. 2024 Feb 14;23(1):e12563. doi: 10.1002/rmb2.12563. eCollection 2024 Jan-Dec.

Authors

Shiori Kumazawa¹, Kazuki Saito², Nanako Hashido¹, Rinko Ibi³, Tomonori Ishikawa², Akira Wakabayashi³, Naoyuki Miyasaka¹

Affiliations

¹ Department of Comprehensive Reproductive Medicine, Graduate School Tokyo Medical and Dental University Tokyo Japan.
² Department of Perinatal and Maternal Medicine (Ibaraki), Graduate School Tokyo Medical and Dental University Tokyo Japan.
³ Department of Obstetrics and Gynecology Tokyo Metropolitan Hiroo Hospital Tokyo Japan.

Abstract

Purpose: This study aimed to elucidate the factors that affect the dynamics of blood D-dimer in ovarian hyperstimulation syndrome (OHSS).

Methods: We retrospectively reviewed medical records from two hospitals and extracted data obtained during assisted reproductive technology and OHSS treatment. Blood D-dimer levels during hospitalization were plotted against body weight. Other factors possibly related to blood D-dimer levels were also analyzed.

Results: The analysis included 10 patients with OHSS admitted between January 2013 and June 2023. In all patients, blood D-dimer levels increased significantly when they convalesced from OHSS and lost weight. None of the patients showed clinical signs of thrombosis, which was confirmed using imaging tests in 8 of 10 patients. Two patients underwent cell-free and concentrated ascites reinfusion therapy (CART), and their blood D-dimer levels increased dramatically after the procedure.

Conclusion: Weight change and CART are associated with blood D-dimer dynamics in OHSS. Our results show that elevated blood D-dimer levels in patients with OHSS do not always represent the presence of thrombosis. Reinfusion of pooled D-dimer in ascites may explain the D-dimer surge during the recovery phase or after CART in these patients. Our study provides new perspectives on the clinical implications of D-dimer during OHSS.

Keywords: D‐dimer; VEGF; ovarian hyperstimulation syndrome; peritoneal effusion; venous thromboembolism.