低分子量ヘパリンと胎盤による再発性妊娠合併症:ランダム化制御試験の個々の患者データのメタ分析
Marc A Rodger1, Jean-Christophe Gris2, Johanna I P de Vries3
1Ottawa Blood Disease Center, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Lancet (London, England)
|October 11, 2016
まとめ
低分子量ヘパリンは,胎盤による妊娠合併症の再発を有意に防ぐことはできませんでした. しかし,多センター試験で胎盤剥離歴のある患者ではリスクを軽減する可能性があります.
科学分野:
- 産婦人科
- 妊婦と胎児の医療
- 薬理学について
背景:
- 胎盤による妊娠合併症である 妊娠前出血症やSGA出産は 母親と新生児の健康に重大なリスクをもたらします
- 再発は一般的ですが 効果的な予防策は不足しています
- 以前のメタ解析では,低分子量ヘパリン (LMWH) の有効性が示唆されたが,異質性が認められた.
研究 の 目的:
- 胎盤による再発性妊娠合併症の予防におけるLMWHの有効性を明らかにするために,個々の患者データメタ分析を行う.
- LMWH治療から恩恵を受ける特定の患者のサブグループとアウトカムを特定する.
主な方法:
- 特定の妊娠合併症の歴のある女性を含む8件のランダム化試験 (2000年−2013年) の体系的レビュー.
- 個々の患者のデータが要求され,組み合わせられ,分析されました.
- 主要アウトカム: 早期/重度の妊娠前出血症,SGA新生児 (< 5 番目の百分位),妊娠中絶 (≥ 20 週),または出産を必要とする突然出血症の複合体.
主要な成果:
- 分析には963人の女性 (480人のLMWH,483人の対照群) が含まれており,42%が血栓性であった.
- 全体的に,LMWHは主要な複合結果 (14%対22%,p=0. 09) を有意に低下させなかった.
- 亜群分析により,前もって胎盤が切断された女性のマルチセンター試験におけるLMWHが有意に減少したことが明らかになった (p=0. 006).
結論:
- リスクの高い女性では,LMWHは胎盤による再発性妊娠合併症を一般的には防ぐことができないようです.
- 多中心環境での胎盤剥離歴のある女性など,特定のサブグループに潜在的な利益がある可能性があります.
- 小規模な効果を検出するには,より高い統計力を備えたさらなる研究が必要になる可能性があります.
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