PMID- 33687789
OWN - NLM
STAT- MEDLINE
DCOM- 20210521
LR  - 20230829
IS  - 1538-7836 (Electronic)
IS  - 1538-7933 (Print)
IS  - 1538-7836 (Linking)
VI  - 19
IP  - 5
DP  - 2021 May
TI  - Antithrombotic therapy to prevent recurrent pregnancy loss in antiphospholipid 
      syndrome-What is the evidence?
PG  - 1174-1185
LID - 10.1111/jth.15290 [doi]
AB  - Aspirin and heparin are widely used to reduce the risk of recurrent pregnancy 
      loss in women with antiphospholipid syndrome. This practice is based on only a 
      few intervention studies, and uncertainty regarding benefits and risk remains. In 
      this case-based review, we summarize the available evidence and address the 
      questions that are most important for clinical practice. We performed a 
      systematic review of randomized controlled trials assessing the effect of heparin 
      (low molecular weight heparin [LMWH] or unfractionated heparin [UFH]), aspirin, 
      or both on live birth rates in women with persistent antiphospholipid antibodies 
      and recurrent pregnancy loss. Eleven trials including 1672 women met the 
      inclusion criteria. Aspirin only did not increase live birth rate compared to 
      placebo in one trial of 40 women (risk ratio [RR] 0.94; 95% confidence interval 
      [CI] 0.71-1.25). One trial of 141 women reported a higher live birth rate with 
      LMWH only than with aspirin only (RR 1.20; 95% CI 1.00-1.43). Five trials 
      totaling 1295 women compared heparin plus aspirin with aspirin only. The pooled 
      RR for live birth was 1.27 (95% CI 1.09-1.49) in favor of heparin plus aspirin. 
      There was significant heterogeneity between the subgroups of LMWH and UFH (RR for 
      LWMH plus aspirin versus aspirin 1.20, 95% CI: 1.04-1.38; RR for UFH plus aspirin 
      versus aspirin 1.74, 95% CI: 1.28-2.35; I(2)  78.9%, p = .03). Characteristics of 
      participants and adverse events were not uniformly reported. Heparin (LMWH or 
      UFH) plus aspirin may improve live birth rates in women with recurrent pregnancy 
      loss and antiphospholipid antibodies, but evidence is of low certainty.
CI  - (c) 2021 The Authors. Journal of Thrombosis and Haemostasis published by Wiley 
      Periodicals LLC on behalf of International Society on Thrombosis and Haemostasis.
FAU - Hamulyak, Eva N
AU  - Hamulyak EN
AUID- ORCID: 0000-0002-9340-8771
AD  - Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam 
      UMC, University of Amsterdam, Amsterdam, the Netherlands.
FAU - Scheres, Luuk J J
AU  - Scheres LJJ
AUID- ORCID: 0000-0001-5282-5520
AD  - Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam 
      UMC, University of Amsterdam, Amsterdam, the Netherlands.
AD  - Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS, 
      Radboud University Medical Center, Nijmegen, the Netherlands.
FAU - Goddijn, Mariette
AU  - Goddijn M
AUID- ORCID: 0000-0001-9928-9673
AD  - Center for Reproductive Medicine, Department of Obstetrics and Gynecology, 
      Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
FAU - Middeldorp, Saskia
AU  - Middeldorp S
AUID- ORCID: 0000-0002-1006-6420
AD  - Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam 
      UMC, University of Amsterdam, Amsterdam, the Netherlands.
AD  - Department of Internal Medicine & Radboud Institute of Health Sciences (RIHS, 
      Radboud University Medical Center, Nijmegen, the Netherlands.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20210326
PL  - England
TA  - J Thromb Haemost
JT  - Journal of thrombosis and haemostasis : JTH
JID - 101170508
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Heparin, Low-Molecular-Weight)
RN  - 9005-49-6 (Heparin)
SB  - IM
MH  - *Abortion, Habitual/prevention & control
MH  - Anticoagulants/adverse effects
MH  - *Antiphospholipid Syndrome/complications/diagnosis/drug therapy
MH  - Female
MH  - Fibrinolytic Agents/adverse effects
MH  - Heparin
MH  - Heparin, Low-Molecular-Weight/therapeutic use
MH  - Humans
MH  - Pregnancy
PMC - PMC8252114
OTO - NOTNLM
OT  - antiphospholipid syndrome
OT  - heparin
OT  - live birth
OT  - recurrent pregnancy loss-aspirin
COIS- S. Middeldorp reports grants and fees paid to her institution from GSK, 
      BMS/Pfizer, Aspen, Daiichi Sankyo, Bayer, Boehringer Ingelheim, Sanofi, and 
      Portola. L.J.J. Scheres received funding for the printing of his doctoral thesis 
      from the Dutch Heart Foundation, Dutch Federation of Coagulation Clinics, 
      Stichting tot Steun Promovendi Vasculaire Geneeskunde, Bayer, Daiichi Sankyo, LEO 
      Pharma, and Pfizer, outside the submitted work. M. Goddijn works at the 
      Department of Reproductive Medicine of the Amsterdam UMC (location AMC and 
      location VUmc). Location VUMC has received several research and educational 
      grants from Guerbet, Merck, and Ferring, not related to the presented work. E.N. 
      Hamulyak has nothing to disclose.
EDAT- 2021/03/10 06:00
MHDA- 2021/05/22 06:00
PMCR- 2021/07/02
CRDT- 2021/03/09 12:16
PHST- 2021/02/26 00:00 [revised]
PHST- 2020/10/14 00:00 [received]
PHST- 2021/03/01 00:00 [accepted]
PHST- 2021/03/10 06:00 [pubmed]
PHST- 2021/05/22 06:00 [medline]
PHST- 2021/03/09 12:16 [entrez]
PHST- 2021/07/02 00:00 [pmc-release]
AID - S1538-7836(22)00764-4 [pii]
AID - JTH15290 [pii]
AID - 10.1111/jth.15290 [doi]
PST - ppublish
SO  - J Thromb Haemost. 2021 May;19(5):1174-1185. doi: 10.1111/jth.15290. Epub 2021 Mar 
      26.