Category: Medical/Surgical/Diseases/Complications
Poster Session III
Cancer currently occurs in about 1 in 1000 pregnancy. Both cancer and pregnancy are individual risk factors for venous thromboembolism (VTE). The purpose of this systematic review was to evaluate the rate of VTE in pregnant patients with active malignancy compared to pregnant patients without malignancy.
Study Design:
Embase, PubMed, Cochrane Database and clinicaltrial.gov were search from inception until June 2021 by a trained librarian. Search strategy included key words related to pregnancy, neoplasm and thrombosis. Of the 3821 articles screened, 7 cohort studies were included. Studies were included if reported VTE rate in patients with active malignancy in pregnancy. RevMan software was used to calculate odds ratio (OR). This trial was PROSPERO registered.
Results:
Two authors reviewed studies independently. Included studies were of high quality, low bias using the Newcastle-Ottawa scale. 5928 individuals had active malignancy and pregnancy. Active malignancy in pregnancy significantly increased the odds of a VTE (OR 6.7, 95% CI 3.7-12.1). Specifically, thyroid (OR 2.7, 95% CI 1.3-6.3), cervix (OR 6.5, 95% CI 2.2-18.9), other gynaecological (OR 10.6, 95% CI 4.4-25.8), Hodgkin’s lymphoma (OR 8.7, 95% CI 3.3-23.4) and acute leukemia (OR 17.1, 95% CI 10.9-26.8) patients all had increased odds, while brain (OR 6.1, 95% CI 0.4-98.2), breast (OR 2.5, 95% CI 0.3-17.4), malignant melanoma (OR 5.5, 95% CI 0.3-88.1) and non-Hodgkin’s lymphoma (OR 3.2, 95% CI 0.8-12.9) malignancies did not increase odds for VTE. No studies reported if prophylactic anticoagulation was offered during pregnancy in this population; nor did they report timing in pregnancy of the VTE.
Conclusion:
Pregnancy with active malignancy confers a significant increased risk for VTE compared to pregnant patients without malignancy. Given this finding, prophylactic anticoagulation during pregnancy and postpartum should be considered in this patient population. Data is underpowered to make firm recommendations per cancer type.
Christopher M. Nash, BSc, MD, MSc (he/him/his)
Assistant Professor
Dalhousie University
Halifax, Canada, Canada
Ashley Miller, BSc, MD, MSc
Assistant Professor
Dalhousie University
Halifax, Canada, Canada
Sara Folkins, BSc
Medical Student
Dalhousie University
Halifax, Canada, Canada