Венозные и артериальные тромбозы в программах ВРТ: эпидемиология и превентивные стратегии

В данном обзоре представлены современные данные о взаимосвязи между процедурами экстракорпорального оплодотворения (ЭКО) и тромботическими осложнениями с акцентом на эпидемиологические, патофизиологические и клинические аспекты. Тромбоз, хотя и является редким осложнением ЭКО (частота составляет около 0,2 %), представляет собой серьезную проблему, особенно у пациенток с синдромом гиперстимуляции яичников (СГЯ). При СГЯ риск тромботических осложнений значительно возрастает, что подчеркивает необходимость тщательного мониторинга и профилактики. Артериальные тромбозы, хотя и встречаются реже венозных, чаще связаны с СГЯ и возникают на ранних этапах после стимуляции. Также характерна атипичная локализация тромбозов: верхние конечности, шея и церебральные вены. Риск тромбообразования наиболее высок в I триместре беременности, наступившей в результате ЭКО, и может сохраняться в течение нескольких недель после разрешения СГЯ. К ключевым факторам риска тромботических осложнений относятся: СГЯ, который увеличивает риск тромбозов в 100 раз; тромбофилия (как наследственная, так и приобретенная), особенно у женщин с множественными факторами риска; ожирение, которое ассоциировано с повышением уровня эстрогенов и прокоагулянтных факторов; возраст матери старше 35 лет; синдром поликистозных яичников, который увеличивает риск венозных тромботических осложнений в 5 раз. Особое внимание уделено стратегиям снижения риска тромботических осложнений. Использование ревитализированных эмбрионов может значительно снизить риск тромбозов по сравнению с переносом свежих эмбрионов, что связано с отсутствием значительного повышения уровня эстрогенов и исключением риска СГЯ.

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