Risk of venous thromboembolism in pregnant patients with active malignancy: A systematic review and meta‐analysis
Abstract Introduction Cancer currently occurs in about 1 in 1000 pregnancies. Both active malignancy and pregnancy are individual risk factors for venous thromboembolism (VTE). The purpose of this systematic review/meta‐analysis was to evaluate the rate of VTE in pregnant patients with active malign...
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Wiley
2024-04-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.14712 |
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| author | Sara Folkins Ashley Miller Christopher M. Nash |
| author_facet | Sara Folkins Ashley Miller Christopher M. Nash |
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| description | Abstract Introduction Cancer currently occurs in about 1 in 1000 pregnancies. Both active malignancy and pregnancy are individual risk factors for venous thromboembolism (VTE). The purpose of this systematic review/meta‐analysis was to evaluate the rate of VTE in pregnant patients with active malignancy compared with pregnant patients without malignancy. Material and methods Embase, Medline/PubMed, Cochrane Database, and clinicaltrial.gov were search by a trained librarian from inception until June 2021, and limited to English and French language human studies using keywords related to pregnancy, neoplasm, and thrombosis. This study was prospectively registered with PROSPERO (CRD42021245886). Title, abstract, and full‐text review was performed using the Covidence data management system. Two authors reviewed the studies independently. Of the 3821 articles screened, seven cohort studies were included that reported VTE rate in patients with active malignancy in pregnancy. Results A total of 5928 individuals had active malignancy and pregnancy. Active malignancy in pregnancy significantly increased the odds of a VTE (odds ratio [OR] 6.8, 95% confidence interval [CI] 3.8–12.1). Specifically, patients with thyroid (OR 2.7, 95% CI 1.3–6.3), cervix (OR 6.6, 95% CI 2.4–18.0), or other gynecological (OR 10.6, 95% CI 4.4–25.8) cancers; Hodgkin's lymphoma (OR 8.7, 95% CI 3.3–23.4); or acute leukemia (OR 17.1, 95% CI 10.9–26.8) all had increased odds, whereas those with brain cancer (OR 6.1, 95% CI 0.4–98.2), breast cancer (OR 2.5, 95% CI 0.3–17.4), malignant melanoma (OR 5.5, 95% CI 0.3–88.1), or non‐Hodgkin's lymphoma (OR 3.2, 95% CI 0.8–12.9) malignancies did not have statistically significant increased odds for VTE. No studies reported whether prophylactic anticoagulation was used during pregnancy in this population; nor did they report timing in pregnancy of the VTE. The absolute risk for VTE in those with active malignancy was 0.9% compared with 0.2% in those without active malignancy in pregnancy. Conclusions Pregnancy with active malignancy confers a significant increased risk for VTE compared with pregnancy alone. Given this finding, prophylactic anticoagulation during pregnancy and postpartum could be considered in this patient population. Data are underpowered to make firm recommendations per cancer type. |
| format | Article |
| id | doaj-art-01e0cbfa7c0443e48295e6a04b845ce0 |
| institution | OA Journals |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2024-04-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-01e0cbfa7c0443e48295e6a04b845ce02025-08-20T02:09:29ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122024-04-01103464565210.1111/aogs.14712Risk of venous thromboembolism in pregnant patients with active malignancy: A systematic review and meta‐analysisSara Folkins0Ashley Miller1Christopher M. Nash2Dalhousie University Medical School Halifax Nova Scotia CanadaDivision of General Internal Medicine, Department of Medicine Dalhousie University Halifax Nova Scotia CanadaDivision of Maternal‐Fetal Medicine, Department of Obstetrics and Gynaecology Dalhousie University Halifax Nova Scotia CanadaAbstract Introduction Cancer currently occurs in about 1 in 1000 pregnancies. Both active malignancy and pregnancy are individual risk factors for venous thromboembolism (VTE). The purpose of this systematic review/meta‐analysis was to evaluate the rate of VTE in pregnant patients with active malignancy compared with pregnant patients without malignancy. Material and methods Embase, Medline/PubMed, Cochrane Database, and clinicaltrial.gov were search by a trained librarian from inception until June 2021, and limited to English and French language human studies using keywords related to pregnancy, neoplasm, and thrombosis. This study was prospectively registered with PROSPERO (CRD42021245886). Title, abstract, and full‐text review was performed using the Covidence data management system. Two authors reviewed the studies independently. Of the 3821 articles screened, seven cohort studies were included that reported VTE rate in patients with active malignancy in pregnancy. Results A total of 5928 individuals had active malignancy and pregnancy. Active malignancy in pregnancy significantly increased the odds of a VTE (odds ratio [OR] 6.8, 95% confidence interval [CI] 3.8–12.1). Specifically, patients with thyroid (OR 2.7, 95% CI 1.3–6.3), cervix (OR 6.6, 95% CI 2.4–18.0), or other gynecological (OR 10.6, 95% CI 4.4–25.8) cancers; Hodgkin's lymphoma (OR 8.7, 95% CI 3.3–23.4); or acute leukemia (OR 17.1, 95% CI 10.9–26.8) all had increased odds, whereas those with brain cancer (OR 6.1, 95% CI 0.4–98.2), breast cancer (OR 2.5, 95% CI 0.3–17.4), malignant melanoma (OR 5.5, 95% CI 0.3–88.1), or non‐Hodgkin's lymphoma (OR 3.2, 95% CI 0.8–12.9) malignancies did not have statistically significant increased odds for VTE. No studies reported whether prophylactic anticoagulation was used during pregnancy in this population; nor did they report timing in pregnancy of the VTE. The absolute risk for VTE in those with active malignancy was 0.9% compared with 0.2% in those without active malignancy in pregnancy. Conclusions Pregnancy with active malignancy confers a significant increased risk for VTE compared with pregnancy alone. Given this finding, prophylactic anticoagulation during pregnancy and postpartum could be considered in this patient population. Data are underpowered to make firm recommendations per cancer type.https://doi.org/10.1111/aogs.14712cancermalignancypregnancysystematic reviewthromboprophylaxisvenous thromboembolism |
| spellingShingle | Sara Folkins Ashley Miller Christopher M. Nash Risk of venous thromboembolism in pregnant patients with active malignancy: A systematic review and meta‐analysis Acta Obstetricia et Gynecologica Scandinavica cancer malignancy pregnancy systematic review thromboprophylaxis venous thromboembolism |
| title | Risk of venous thromboembolism in pregnant patients with active malignancy: A systematic review and meta‐analysis |
| title_full | Risk of venous thromboembolism in pregnant patients with active malignancy: A systematic review and meta‐analysis |
| title_fullStr | Risk of venous thromboembolism in pregnant patients with active malignancy: A systematic review and meta‐analysis |
| title_full_unstemmed | Risk of venous thromboembolism in pregnant patients with active malignancy: A systematic review and meta‐analysis |
| title_short | Risk of venous thromboembolism in pregnant patients with active malignancy: A systematic review and meta‐analysis |
| title_sort | risk of venous thromboembolism in pregnant patients with active malignancy a systematic review and meta analysis |
| topic | cancer malignancy pregnancy systematic review thromboprophylaxis venous thromboembolism |
| url | https://doi.org/10.1111/aogs.14712 |
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