Other publication
Low-Molecular-Weight Heparin and Recurrent Placenta-Mediated Pregnancy Complications: A Meta-analysis of Individual Patient Data From Randomised Controlled Trials
Authors: Rodger MA, Gris JC, de Vries JIP, Martinelli I, Rey E, Schleussner E, Middeldorp S, Kaaja R, Langlois NJ, Ramsay T, Mallick R, Bates SM, Abheiden CNH, Perna A, Petroff D, de Jong P, van Hoorn ME, Bezemer PD, Mayhew AD
Publication year: 2017
Journal: Obstetrical and Gynecological Survey
Volume: 72
Issue: 3
First page : 153
Last page: 155
Number of pages: 4
ISSN: 0029-7828
eISSN: 1533-9866
DOI: https://doi.org/10.1097/01.ogx.0000513226.69777.83
Placenta-mediated pregnancy complications include pre-eclampsia, birth
of a small-for-gestational-age neonate, placental abruption, or late
pregnancy loss and lead to maternal and fetal or neonatal morbidity and
mortality. These complications have a high risk of recurring in
subsequent pregnancies, and effective preventive measures are lacking.
Findings from some randomized controlled trials suggest that
low-molecular-weight heparin (LMWH) can be used to prevent recurrent
placentamediated pregnancy complications, but these findings have not
been universal.
An individual patient data meta-analysis was done to evaluate the
efficacy of LMWH to prevent recurrent placentamediated complications in
subsequent pregnancies. The primary outcome was a composite of 4
pregnancy complications: early-onset or severe preeclampsia, birth of a
small-for-gestational-age neonate (birth weight less than the fifth
percentile), placental abruption, and late pregnancy loss. The data set
included a total of 963 eligiblewomen from 8 randomized published
trials. The primary outcome analysis showed that LMWH did not
significantly reduce the risk of recurrent placenta-mediated pregnancy
complications (LMWH 62/444 [14%] vs no LMWH 95/443 [22%]; absolute
difference, 8% [95% confidence interval, 17.3-1.4; P = 0.09]; relative
risk, 0.64 [95% confidence interval, 0.36-1.11; P = 0.11]). Significant
heterogeneity was noted between single-center and multicenter trials for
the primary composite outcomes and also in the subgroup analyses.
Low-molecular-weight heparin was found to be beneficial in women with
previous placental abruption in both single-center and multicenter
trials but not in any other subgroups of previous complications. No
serious adverse reaction to LMWHwas observed. Inclusion of individual
patient data set enabled a robust exploration of clinical,
methodological, and statistical heterogeneity. In conclusion, this
individual patient data meta-analysis showed that LMWH did not
significantly reduce the risk of recurrent placenta-mediated pregnancy
complications in women with previous complications.
