低分子量肝素和复发的胎盘介导妊娠并发症:随机对照试验中的个体患者数据的元分析
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
概括
在有风险的妇女中,低分子量肝素没有显著地预防复发的胎盘介导妊娠并发症. 然而,在多中心试验中,它可能会降低有胎盘脱落史的人的风险.
科学领域:
- 产科和妇科
- 产妇和胎儿医学
- 药理学
背景情况:
- 胎盘引起的妊娠并发症,如子宫前和SGA分娩,对母亲和新生儿的健康构成重大风险.
- 这种情况很常见, 但缺乏有效的预防策略.
- 之前的元分析表明低分子量肝素 (LMWH) 的有效性,但注意到异质性.
研究的目的:
- 进行个体患者数据的分析,以澄清LMWH在预防复发的胎盘介导妊娠并发症方面的有效性.
- 确定从LMWH治疗中受益的特定患者子组和结果.
主要方法:
- 对8项随机试验 (2000 - 2013) 的系统审查,这些试验涉及有特定妊娠并发症的妇女.
- 要求收集个别患者的数据,并进行组合和分析.
- 主要结局:早期/ 严重的妊娠前,SGA新生儿 (< 5 个百分位),晚期妊娠失败 (≥ 20 周) 或需要分娩的突发性.
主要成果:
- 分析包括963名女性 (480名LMWH,483名对照女性);42%的女性患有血栓友症.
- 总体而言,LMWH没有显著降低初级复合结果 (14%与22%,p=0. 09).
- 小组分析显示,在多中心试验中,LMWH显著降低了先前有胎盘脱落的女性的结果 (p=0. 006).
结论:
- 在有风险的妇女中,LMWH似乎不能广泛预防复发的胎盘介导的妊娠并发症.
- 对于特定的子组可能存在潜在的益处,例如在多中心环境中有胎盘断裂史的妇女.
- 可能需要增加统计能力的进一步研究来检测更小的效应大小.
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