Abstract 134: Thrombotic Complications of Ovarian Hyperstimulation Syndrome

Abstract

Introduction: Ovarian hyperstimulation syndrome (OHSS) is a well-known complication of ovarian stimulation used during assisted reproductive technology cycles. In severe OHSS, increases in capillary permeability can result in hemoconcentration and hypercoagulability leading to thrombotic events, including stroke and cerebral venous thrombosis. Herein we sought to determine the prevalence of hospitalization for thrombotic events shortly after OHSS using population-level data. Methods: We conducted two separate retrospective cohort studies of patients with OHSS using publicly available datasets: (1) administrative claims data from the Healthcare Cost and Utilization Project (HCUP) across 11 states from 2016 to 2020 and (2) National Inpatient Sample (NIS) registry data from the end of 2015 to 2020. HCUP contains both emergency department and inpatient encounters whereas NIS contains a nationally representative sample of inpatient encounters. For our study, all female patients with an encounter for OHSS, defined using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code N98.1 were included from each dataset. Our primary study outcome was any stroke or major thrombotic event identified within 60 days of OHSS diagnosis in HCUP or during the index admission for OHSS in NIS. We used previously validated ICD-10-CM codes for acute ischemic stroke, intracerebral and subarachnoid hemorrhage, cerebral venous thrombosis, acute myocardial infarction, pulmonary embolism, and acute deep venous thrombosis to define our study outcome. Results: We identified a total of 747 patients with OHSS in HCUP. Within the HCUP cohort, fewer than 10 patients (<1%) were hospitalized with a stroke or thrombotic event within 60 days of OHSS diagnosis. There were 1,955 hospitalizations for OHSS in NIS. There were 20 (1%) pulmonary embolisms and 35 (1.8%) acute deep venous thromboses, but no other stroke/thrombotic complications in NIS. Conclusions: We found very few thrombotic events shortly after OHSS diagnosis using two large datasets. The low rate of outcome events after OHSS seen in each of our population-level analyses increases the reliability of these study results.