Internal jugular vein thrombosis in patients with ovarian hyperstimulation syndrome

Objective: To describe a case of bilateral internal jugular vein thrombosis complicating ovarian hyperstimulation syndrome (OHSS). Design: Case report. Setting: Internal medicine ward in a teaching hospital. Patient: A 28-year-old nulliparous woman undergoing IVF. Intervention(s): Ultrasonographic Doppler of the neck veins was performed because of pain and swelling in the neck, and bilateral jugular vein thromboses were detected. Laboratory evaluation revealed activated protein C resistance caused by factor V Leiden mutation. Low-molecular-weight heparin (enoxaparin) was administered for the remainder of the pregnancy and for 6 weeks after delivery. Main Outcome Measure: Resolution of jugular venous thromboses documented by ultrasonographic Doppler and normal progression of pregnancy. Result(s): The patient delivered healthy twins at term. There were no complications arising from the jugular vein thromboses or the low-molecular- weight heparin treatment. Conclusion(s): Unusually located venous thrombosis should prompt an evaluation for a hypercoagulable state. The high prevalence (4%-7%) of factor V Leiden mutation in most Western populations and the mutation's potential contribution to thrombotic complications in OHSS suggest that screening for this abnormality in women undergoing IVF may be indicated.