Antithrombotic Treatment for Recurrent Miscarriage: Bayesian Network Meta-Analysis and Systematic Review

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Reproductive Medicine

Background:

• Recurrent miscarriage (RM) treatment often involves heparin and aspirin, particularly for antiphospholipid syndrome (APS) or thrombophilia.
• The efficacy of various antithrombotic therapies for improving live birth rates in RM remains uncertain.
• Current treatment strategies are largely based on expert opinion rather than robust clinical evidence.

Purpose of the Study:

• To evaluate the effects of different antithrombotic treatments on preventing pregnancy losses in patients with recurrent miscarriage.
• To compare the efficacy of various antithrombotic therapies using direct and indirect evidence from randomized clinical trials.

Main Methods:

• A network meta-analysis was conducted, incorporating data from 19 randomized clinical trials.
• Searched PubMed and Embase databases for trials published from 1965 to May 2015.
• Assessed risk of bias using Cochrane Collaboration guidelines and employed Bayesian network meta-analysis to estimate relative effects on live birth.

Main Results:

• The analysis included 2391 RM patients (with or without thrombophilia) and 543 with APS.
• No significant beneficial effect of antithrombotic treatment was observed across all RM patient groups.
• For patients with or without thrombophilia, low molecular weight heparin showed the highest probability (61.48%) of being the best option for live birth.
• In APS patients, unfractionated heparin plus aspirin demonstrated the highest likelihood (75.15%) of being among the top treatments for reducing pregnancy losses.
• Aspirin alone was found to be inferior in both patient groups and may negatively impact pregnancy loss risk.

Conclusions:

• The findings do not support the routine use of combined low molecular weight heparin and aspirin for RM treatment.
• Aspirin monotherapy may be detrimental, potentially increasing the risk of pregnancy loss in RM patients.
• Further research is needed to clarify optimal antithrombotic strategies for specific RM patient subgroups.