Given the efficacy and safety of recombinant human activated
protein C (
rhAPC) in the
systemic inflammatory response syndrome (SIRS), this study was designed to review the evidence for
rhAPC as a possible therapeutic option in the treatment of severe
ovarian hyperstimulation syndrome (OHSS). SIRS, like OHSS, is a proinflammatory and prothrombotic disorder whose cornerstone is endothelial dysfunction in which
protein C deficiency is a frequent occurrence. Recently, the use of
rhAPC has been shown to be of benefit with a reduction in mortality and an improvement in indicators of
inflammation and coagulation. OHSS is typically an iatrogenic disorder resulting from ovarian stimulation as a component of
infertility treatment. The pathogenesis of OHSS, like
sepsis, is related to endothelial dysfunction and
inflammation and can result in significant morbidity including end organ hypoperfusion,
disseminated intravascular coagulation (
DIC),
thrombosis, and occasionally, death. We have performed a review of the literature to identify similarities between these disease processes to develop a theoretical basis for the use of
rhAPC in patients with moderate to severe OHSS. Use of
rhAPC in this group may attenuate the disease process and reduce the potential morbidity associated with this iatrogenic disorder.