PMID- 33171281
OWN - NLM
STAT- MEDLINE
DCOM- 20211021
LR  - 20211021
IS  - 2468-7847 (Electronic)
IS  - 2468-7847 (Linking)
VI  - 50
IP  - 2
DP  - 2021 Feb
TI  - Heparin for preventing adverse obstetrical outcomes in pregnant women with 
      antiphospholipid syndrome, a systematic review and meta-analysis.
PG  - 101974
LID - S2468-7847(20)30344-5 [pii]
LID - 10.1016/j.jogoh.2020.101974 [doi]
AB  - BACKGROUND: We performed a systematic review and meta-analysis to assess the 
      efficacy and safety of heparin for preventing adverse obstetrical outcomes in 
      pregnant women with antiphospholipid syndrome (APS). METHODS: We reviewed 
      randomized controlled trials from CENTRAL, EMBASE, MEDLINE, and Web of science 
      (inception to November 5th 2019), and relevant article reference lists. Two 
      reviewers independently screened and extracted data from trials investigating 
      heparin, including Low Molecular Weight Heparin (LMWH) and unfractionated heparin 
      (UFH) at any dose, associated or not with aspirin, compared to any comparator 
      group in pregnant women with APS. Internal validity was assessed in duplicate 
      using the Cochrane Risk of Bias tool. The strength of evidence was assessed in 
      duplicate using the Grading of Recommendations Assessment, Development and 
      Evaluation framework. Our primary outcome was live birth rate. Secondary outcomes 
      included preeclampsia, preterm birth, intra-uterine growth restriction (IUGR) and 
      thromboembolism. Safety outcomes included maternal or neonatal bleedings, 
      heparin-induced thrombocytopenia and allergy. Subgroup analyses were conducted to 
      explore heterogeneity. RESULTS: From 2395 identified citations, 13 trials (1916 
      patients) met inclusion criteria. Heparin, associated or not with aspirin, 
      significantly increased the rate of live birth compared to any comparator (RR 
      1.20; 95 % CI 1.09-1.33, I(2) = 67 %, 1916 patients, low-certainty evidence). In 
      subgroup analyses, LMWH and UFH were independently associated with greater rates 
      of live birth: RR 1.15 (95 % CI 1.04-1.28, I(2) = 71 %, 1684 patients, 9 trials) 
      and RR 1.45 (95 % CI 1.16-1.81, I(2) = 19 %, 149 patients, 4 trials) 
      respectively. Heparin associated or not to aspirin, significantly decreased the 
      rate of preeclampsia compared to any comparator (RR 0.32; 95 % CI 0.12-0.87, I(2) 
      = 0%, 465 patients, 8 trials) but was not associated with differential rates of 
      preterm birth nor IUGR. Heparin was associated with minor bleeding (bruises, 
      epistaxis): RR 2.58 (95 % CI 1.03-6.43, I(2) = 16 %, 653 patients, 9 trials). No 
      serious maternal or neonatal adverse events were reported in the included 
      studies. CONCLUSIONS: In pregnant women with APS, heparin, associated or not to 
      aspirin, significantly improved the live birth rate compared to any comparator 
      and decreased the risk of preeclampsia, without increasing maternal and neonatal 
      severe morbidity.
CI  - Copyright (c) 2020 Elsevier Masson SAS. All rights reserved.
FAU - Guerby, Paul
AU  - Guerby P
AD  - Reproduction, Mother and Child Health Unit, CHU de Quebec - Universite Laval 
      Research Center, Universite Laval, Quebec City, Quebec, Canada; Department of 
      Obstetrics and Gynecology, Paule de Viguier Hospital, CHU de Toulouse, Inserm 
      U-1048, Universite de Toulouse, Toulouse, France. Electronic address: 
      paul.guerby@gmail.com.
FAU - Fillion, Alexandre
AU  - Fillion A
AD  - Reproduction, Mother and Child Health Unit, CHU de Quebec - Universite Laval 
      Research Center, Universite Laval, Quebec City, Quebec, Canada.
FAU - O'Connor, Sarah
AU  - O'Connor S
AD  - Faculty of Pharmacy, Institut universitaire de cardiologie et pneumologie de 
      Quebec (IUCPQ), Universite Laval, Quebec, Canada.
FAU - Bujold, Emmanuel
AU  - Bujold E
AD  - Reproduction, Mother and Child Health Unit, CHU de Quebec - Universite Laval 
      Research Center, Universite Laval, Quebec City, Quebec, Canada; Department of 
      Gynecology, Obstetrics and Reproduction, Faculty of Medicine, Universite Laval, 
      Quebec City, Quebec, Canada.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20201107
PL  - France
TA  - J Gynecol Obstet Hum Reprod
JT  - Journal of gynecology obstetrics and human reproduction
JID - 101701588
RN  - 0 (Anticoagulants)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Antiphospholipid Syndrome/*drug therapy
MH  - Contusions/etiology
MH  - Epistaxis/etiology
MH  - Female
MH  - Heparin/*therapeutic use
MH  - Humans
MH  - Live Birth
MH  - Pre-Eclampsia/prevention & control
MH  - Pregnancy
OTO - NOTNLM
OT  - Anticoagulation
OT  - Antiphospholipid syndrome
OT  - Heparin
OT  - Pregnancy
COIS- Declaration of Competing Interest The authors have no financial or other conflict 
      of interest to disclose.
EDAT- 2020/11/11 06:00
MHDA- 2023/02/25 06:00
CRDT- 2020/11/10 20:10
PHST- 2020/08/07 00:00 [received]
PHST- 2020/10/27 00:00 [revised]
PHST- 2020/11/03 00:00 [accepted]
PHST- 2020/11/11 06:00 [pubmed]
PHST- 2023/02/25 06:00 [medline]
PHST- 2020/11/10 20:10 [entrez]
AID - S2468-7847(20)30344-5 [pii]
AID - 10.1016/j.jogoh.2020.101974 [doi]
PST - ppublish
SO  - J Gynecol Obstet Hum Reprod. 2021 Feb;50(2):101974. doi: 
      10.1016/j.jogoh.2020.101974. Epub 2020 Nov 7.