Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Semin Thromb Hemost. 2023 Jun;49(4):348-354. doi: 10.1055/s-0042-1759683. Epub 2022 Dec 19.
Cancer and pregnancy induce a procoagulant environment which may lead to maternal and fetal complications, such as venous thromboembolism, fetal growth restriction, and fetal loss. The incidence of hematological malignancies diagnosed during pregnancy is rising, and thrombotic events in such malignancies are not rare. Management of thrombosis during pregnancy poses a therapeutic challenge, that is further exacerbated by the impact of cancer. The available data on managing pregnant women with hematological malignancies are limited to those with myeloproliferative neoplasms, mainly essential thrombocythemia, and, to a lesser extent, polycythemia vera. Low-dose aspirin is recommended throughout pregnancy, and considering treatment with low-molecular-weight heparin and interferon formulations is advised for high-risk patients. Currently, guidelines for handling thrombotic events in pregnant women with lymphoma or leukemia are lacking, and their management is based on data extrapolated from retrospective studies, and guidelines for prevention and treatment of cancer-associated thrombosis. The present case-based review will focus on the complex issue of thrombotic risk in pregnant women with hematological malignancies, specifically myeloproliferative neoplasms, lymphomas, and leukemias.
癌症和妊娠会导致促凝环境，从而可能导致母婴并发症，如静脉血栓栓塞、胎儿生长受限和胎儿丢失。怀孕期间诊断出的血液系统恶性肿瘤的发病率正在上升，此类恶性肿瘤中的血栓事件并不罕见。怀孕期间的血栓管理具有治疗挑战性，而癌症的影响则进一步加剧了这一挑战。关于管理妊娠合并血液系统恶性肿瘤的可用数据仅限于骨髓增殖性肿瘤，主要是特发性血小板增多症，其次是真性红细胞增多症。建议整个怀孕期间使用低剂量阿司匹林，对于高危患者，建议考虑使用低分子量肝素和干扰素制剂进行治疗。目前，尚缺乏处理妊娠合并淋巴瘤或白血病患者血栓事件的指南，其管理是基于从回顾性研究和癌症相关血栓形成的预防和治疗指南中推断的数据。本基于案例的综述将重点关注妊娠合并血液系统恶性肿瘤（特别是骨髓增殖性肿瘤、淋巴瘤和白血病）患者的血栓形成风险这一复杂问题。
