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

Carregando...
Imagem de Miniatura
Citações na Scopus
13
Tipo de produção
article
Data de publicação
2018
Título da Revista
ISSN da Revista
Título do Volume
Editora
HOSPITAL CLINICAS, UNIV SAO PAULO
Citação
CLINICS, v.73, article ID UNSP e368, 7p, 2018
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
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.
Palavras-chave
Cancer, Hospitalization, Pregnancy, Risk Assessment, Venous Thrombosis
Referências
  1. Agnelli G, 2006, ANN SURG, V243, P89, DOI 10.1097/01.sla.0000193959.44677.48
  2. Amant F, 2013, J CLIN ONCOL, V31, P2532, DOI 10.1200/JCO.2012.45.6335
  3. Amant F, 2012, LANCET, V379, P570, DOI [10.1016/j.crwh.2014.08.002, 10.1016/S0140-6736(11)61092-1]
  4. Barros VI, THROMBOPROPHYLAXIS P
  5. Bates SM, 2016, J THROMB THROMBOLYS, V41, P92, DOI 10.1007/s11239-015-1309-0
  6. Bleau N, 2016, J MATERN-FETAL NEO M, V29, P380, DOI 10.3109/14767058.2015.1009439
  7. Dickmann B, 2013, HAEMATOLOGICA, V98, P1309, DOI 10.3324/haematol.2012.073338
  8. Donati MB, 2012, THROMB RES, V129, P348, DOI 10.1016/j.thromres.2011.12.022
  9. Geerts WH, 2008, CHEST, V133, p381S, DOI 10.1378/chest.08-0656
  10. Heit JA, 2000, ARCH INTERN MED, V160, P809, DOI 10.1001/archinte.160.6.809
  11. Heit JA, 2005, ANN INTERN MED, V143, P697, DOI 10.7326/0003-4819-143-10-200511150-00006
  12. Blanquisett AH, 2015, ECANCERMEDICALSCIENC, V9, DOI 10.3332/ecancer.2015.551
  13. Huusom LD, 2011, BJOG-INT J OBSTET GY, V118, P1, DOI 10.1111/j.1471-0528.2010.02782.x
  14. Khorana AA, 2008, BLOOD, V111, P4902, DOI 10.1182/blood-2007-10-116327
  15. Khorana AA, 2007, ONCOLOGIST, V12, P1361, DOI 10.1634/theoncologist.12-11-1361
  16. Khorana AA, 2009, J CLIN ONCOL, V27, P4839, DOI 10.1200/JCO.2009.22.3271
  17. Liu SL, 2009, J OBSTET GYNAECOL CA, V31, P611, DOI 10.1016/S1701-2163(16)34240-2
  18. Lyman GH, 2015, J CLIN ONCOL, V33, P654, DOI 10.1200/JCO.2014.59.7351
  19. Mahe I, 2016, SUPPORT CARE CANCER, V24, P4105, DOI 10.1007/s00520-016-3224-0
  20. Pavlidis NA, 2002, ONCOLOGIST, V7, P279
  21. Pinheiro A.B., 2013, REV BRAS CANC, V59, P351
  22. Prandoni P, 2005, LANCET ONCOL, V6, P401, DOI 10.1016/S1470-2045(05)70207-2
  23. Royal College of Obstetricians and Gynaecologists, 2015, RED RISK VEN THROMB
  24. Sallah S, 2002, THROMB HAEMOSTASIS, V87, P575
  25. Streiff MB, 2010, THROMB RES, V125, pS128, DOI 10.1016/S0049-3848(10)70030-X
  26. Sud S, 2011, AM J RESP CRIT CARE, V184, P1289, DOI 10.1164/rccm.201106-1059OC
  27. Sultan AA, 2013, BMJ-BRIT MED J, V347, DOI 10.1136/bmj.f6099
  28. Sultan AA, 2012, BRIT J HAEMATOL, V156, P366, DOI 10.1111/j.1365-2141.2011.08956.x
  29. Virkus RA, 2011, THROMB HAEMOSTASIS, V106, P304, DOI 10.1160/TH10-12-0823