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Thromb Haemost 2016; 116(05): 868-878
DOI: 10.1160/TH16-02-0169
Coagulation and Fibrinolysis
Schattauer GmbH

LMWH in the prevention of preeclampsia and fetal growth restriction in women without thrombophilia

A systematic review and meta-analysis
Salvatore Andrea Mastrolia
1   Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
2   Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
,
Lena Novack
3   Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
,
Jecko Thachil
4   Department of Hematology, Manchester Royal Infirmary, Manchester, UK
,
Anat Rabinovich
5   Hematology Institute, Soroka University Medical Center, Beer-Sheva, Israel
,
Oleg Pikovsky
5   Hematology Institute, Soroka University Medical Center, Beer-Sheva, Israel
,
Vered Klaitman
2   Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
,
Giuseppe Loverro
1   Department of Obstetrics and Gynecology, Azienda Ospedaliero-Universitaria Policlinico di Bari, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
,
Offer Erez
2   Department of Obstetrics and Gynecology, Soroka University Medical Center, School of Medicine, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
6   Maternity Department D and Obstetrical Day care Unit, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, School of Medicine, Beer Sheva, Israel
› Author Affiliations
Further Information

Publication History

Received: 02 March 2016

Accepted after major revision: 17 June 2016

Publication Date:
11 November 2017 (online)

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Summary

Placental mediated pregnancy complications such as preeclampsia and fetal growth restriction (FGR) are common, serious, and associated with increased morbidity and mortality. We conducted a systematic review and meta-analysis to determine the effect of treatment with low-molecular-weight heparins (LMWHs) for secondary prevention of these complications in non thrombophilic women. We searched the electronic databases PubMed, Scopus, and Cochrane Library for randomised controlled trials addressing this question. Five studies including 403 patients met the inclusion criteria, 68 developed preeclampsia and 118 FGR. The studies were very heterogeneous in terms of inclusion criteria, LMWH preparation, and dosage. Meta-analyses were performed using random-effect models. The overall use of LMWHs was associated with a risk reduction for preeclampsia (Relative risk (RR) 0.366; 95 % confidence interval (CI), 0.219–0.614) and FGR (RR 0.409; 95 % CI, 0.195–0.932) vs. no treatment. From the data available for analysis it appears that the use of Dalteparin is associated with a risk reduction for preeclampsia (p=0.002) and FGR (p<0.001); while Enoxaparin is associated with risk reduction for preeclampsia (p=0.013) but not for FGR (p=0.3). In spite of the small number of studies addressing the research question, and the high variability among them, our meta-analysis found a modest beneficial effect of LMWH for secondary prevention of preeclampsia and FGR. Further studies are needed to address these questions before a definite conclusion can be reached.

Supplementary Material to this article is available online at www.thrombosis-online.com.

Keywords

Dalteparin - Enoxaparin - placental mediated pregnancy complications - randomized controlled trial - secondary prevention

 

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