Risk assessment of venous thromboembolism and thromboprophylaxis in pregnant women hospitalized with cancer: Preliminary results from a risk score

Abstract

OBJECTIVES:Hospitalized patients with cancer are at high risk of developing venous thromboembolism, and the risk increases with pregnancy. The aim of this study was to apply a thromboprophylaxis protocol with a venous thromboembolism risk score for hospitalized pregnant women with cancer and to evaluate the effects on maternal morbidity and mortality.METHODS:A longitudinal and prospective study was conducted from December 2014 to July 2016. The venous thromboembolism risk score was modified from the guidelines of the Royal College of Obstetricians and Gynaecologists. Patients were classified as low (score <3) or high risk (score ≥3). The high-risk group received thromboprophylaxis with low-molecular-weight heparin, unless the patient had a contraindication for anticoagulation. One patient could have undergone more than one evaluation.RESULTS:Fifty-two ratings were descriptively analyzed: 34 (65.4%) were classified as high risk, and 28/34 (82.3%) received low-molecular-weight heparin, 1 received unfractionated heparin, and 5 did not receive intervention. Most patients (23/52; 44.2%) had breast cancer. The main risk factors for venous thromboembolism in the high-risk group were chemotherapy (within 6 months; 22/34; 64.7%). No patient exhibited venous thromboembolism, adverse effects of anticoagulation or death up to three months after hospitalization.CONCLUSIONS:Most pregnant women with cancer had a high risk for venous thromboembolism at the time of hospitalization. Breast cancer was the most prevalent cancer, and recent chemotherapy was the main risk factor for anticoagulation. The application of a thromboprophylaxis protocol and determination of a venous thromboembolism risk score for these patients was useful for the prevention of maternal morbidity and mortality due to venous thromboembolism.

Cancer in pregnancy increases the risk of venous thromboembolism: a nationwide cohort study

“…None of the women receiving thromboprophylaxis had VTE events, adverse effects of anticoagulation, or death up to 3 months after hospitalisation. 18 These findings support the safety of thromboprophylaxis in pregnant women with cancer.…”

“…A recent study evaluated the application of a thromboprophylaxis protocol and VTE risk score (a modified version of the RCOG for pregnant women) for pregnant women with cancer who were hospitalised 18 . Applying this risk score, 65% of the women were classified as having a high risk of VTE (three or more risk points).…”

“…20 A recent study evaluated the application of a thromboprophylaxis protocol and VTE risk score (a modified version of the RCOG for pregnant women) for pregnant women with cancer who were hospitalised. 18 Applying this risk score, 65% of the women were classified as having a high risk of VTE (three or more risk points). Of the high-risk women, 85% received anticoagulation at admission to a hospital or 8 hours postpartum/after surgery (15% had contraindications and were treated with mechanical interventions).…”

“…Little is known about the risk of VTE in pregnant women with cancer. Only two previous studies assessed the combination of cancer with pregnancy and VTE 17,18 . A retrospective population‐based cohort study ( n = 2826) found an increased risk of VTE in pregnant women with Hodgkin's disease, myeloid leukaemia, and cervical and ovarian cancers compared with pregnant women without cancer 17 .…”

Current status of treatment of cancer-associated venous thromboembolism

“…A prospective study compared the maternal morbidity and mortality between 29 pregnant cancer patients with high-risk of VTE receiving parenteral thromboprophylaxis for 3 months and 23 ones with low-risk of VTE not receiving thromboprophylaxis. Among 29 patients receiving thromboprophylaxis, no one exhibited VTE, adverse effects of thromboprophylaxis or death after 3 months of thromboprophylaxis [ 36 ].…”