PMID- 20464719
OWN - NLM
STAT- MEDLINE
DCOM- 20100616
LR  - 20231104
IS  - 1469-493X (Electronic)
IS  - 1361-6137 (Linking)
IP  - 5
DP  - 2010 May 12
TI  - Prophylaxis for venous thromboembolic disease in pregnancy and the early 
      postnatal period.
PG  - CD001689
LID - 10.1002/14651858.CD001689.pub2 [doi]
AB  - BACKGROUND: Venous thromboembolic disease (TED), although rare, is a major cause 
      of maternal mortality and morbidity, hence methods of prophylaxis are often used 
      for women at risk. This may include women delivered by caesarean section, those 
      with a personal or family history of TED and women with inherited or acquired 
      thrombophilias (conditions that predispose people to thrombosis). Many methods of 
      prophylaxis carry a risk of side effects, and as the risk of TED is low, it is 
      possible that the benefits of thromboprophylaxis may be outweighed by harm. 
      Current guidelines for clinical practice are based on expert opinion only, rather 
      than high quality evidence from randomised trials. OBJECTIVES: To determine the 
      effects of thromboprophylaxis in women who are pregnant or have recently 
      delivered and are at increased risk of TED on the incidence of venous TED and 
      side effects of treatment. SEARCH STRATEGY: We searched the Cochrane Pregnancy 
      and Childbirth Group's Trials Register (May 2009). SELECTION CRITERIA: Randomised 
      trials comparing one method of thromboprophylaxis with placebo or no treatment, 
      and randomised trials comparing two (or more) methods of thromboprophylaxis. DATA 
      COLLECTION AND ANALYSIS: Two review authors extracted data independently and 
      resolved any discrepancies by discussion. MAIN RESULTS: Sixteen trials met the 
      inclusion criteria but only 13 trials, involving 1774 women, examining a range of 
      methods of thromboprophylaxis, contributed data for the outcomes of interest. 
      Four of them compared methods of antenatal prophylaxis: low molecular weight 
      heparin (LMWH) versus unfractionated heparin (UFH) (two studies), and heparin 
      versus no treatment (two studies). Eight studies assessed postnatal prophylaxis 
      after caesarean section; one compared hydroxyethyl starch with unfractionated 
      heparin; four compared heparin with placebo; and the other three compared UFH 
      with LMWH. One study examined prophylaxis in the postnatal period.The small 
      number of statistically significant findings in this review are largely derived 
      from trials which are not of high methodological quality. It was not possible to 
      assess the effects of any of these interventions on most outcomes, and especially 
      on rare outcomes such as death, TED and osteoporosis, because of small sample 
      sizes and the small number of trials making the same comparisons.There was some 
      evidence of side effects associated with thromboprophylaxis. AUTHORS' 
      CONCLUSIONS: There is insufficient evidence on which to base recommendations for 
      thromboprophylaxis during pregnancy and the early postnatal period. Large scale 
      randomised trials of currently-used interventions should be conducted.
FAU - Tooher, Rebecca
AU  - Tooher R
AD  - Paediatric Trials Unit, Children,Youth and Women's Health Service, Adelaide, 
      South Australia, Australia, 5006.
FAU - Gates, Simon
AU  - Gates S
FAU - Dowswell, Therese
AU  - Dowswell T
FAU - Davis, Lucy-Jane
AU  - Davis LJ
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20100512
PL  - England
TA  - Cochrane Database Syst Rev
JT  - The Cochrane database of systematic reviews
JID - 100909747
SB  - IM
UIN - Cochrane Database Syst Rev. 2014;2:CD001689. PMID: 24519568
MH  - Female
MH  - Humans
MH  - Postpartum Period
MH  - Pregnancy
MH  - Pregnancy Complications, Hematologic/*prevention & control
MH  - Randomized Controlled Trials as Topic
MH  - Venous Thrombosis/*prevention & control
PMC - PMC4175551
MID - EMS57124
OID - NLM: EMS57124
EDAT- 2010/05/14 06:00
MHDA- 2010/06/17 06:00
PMCR- 2014/09/25
CRDT- 2010/05/14 06:00
PHST- 2010/05/14 06:00 [entrez]
PHST- 2010/05/14 06:00 [pubmed]
PHST- 2010/06/17 06:00 [medline]
PHST- 2014/09/25 00:00 [pmc-release]
AID - 10.1002/14651858.CD001689.pub2 [doi]
PST - epublish
SO  - Cochrane Database Syst Rev. 2010 May 12;(5):CD001689. doi: 
      10.1002/14651858.CD001689.pub2.