目的:系统评价低分子肝素(LMWH)预防无血栓形成高危孕妇子痫前期的疗效。
方法:PubMed,使用组合关键词“先兆子痫”搜索Embase和Cochrane图书馆在2022年8月1日之前发表的文章,“低分子量肝素”,\"LMWH\",\"肝素,低分子量\",\"达肝素\",\"Nadroparin\",和“Tinzaparin”。
方法:评价LMWH在无血栓形成倾向的先兆子痫高危孕妇中的应用的随机对照试验。
方法:10项研究纳入荟萃分析(共1758例患者)。结果表示为具有95%置信区间(CI)的相对风险(RR)。
结果:LMWH降低了无血栓形成的高危孕妇的PE发生率(RR=0.67;95%CI=0.50-0.90;P=0.009)。亚组分析发现,仅在使用低剂量阿司匹林(LDA)作为主要干预措施的研究中,LMWH的预防作用才显着。LMWH和LDA的组合对于预防早产和胎儿生长受限也是有效的,但对胎盘早剥的发生率没有影响。
结论:对于患有先兆子痫而无血栓形成的高风险女性,LMWH和低剂量阿司匹林的组合对于预防先兆子痫是有效的,早产和胎儿生长受限,优于单独的LDA。
OBJECTIVE: To systematically evaluate the efficacy of low molecular weight heparin (LMWH) to prevent preeclampsia in high risk pregnant women without thrombophilia.
METHODS: PubMed, Embase and the Cochrane library were searched for articles published before 1st August 2022 using the combination keywords \"preeclampsia\", \"Low Molecular Weight Heparin\", \"LMWH\", \"Heparin, Low Molecular Weight\", \"Dalteparin\", \"Nadroparin\", and \"Tinzaparin\".
METHODS: Randomized controlled trials evaluating the use of LMWH in pregnant women at high risk of preeclampsia without thrombophilia.
METHODS: Ten studies were included in the meta-analysis (1758 patients in total). Outcomes were expressed as relative risk (RR) with 95% confidence intervals (CI).
RESULTS: LMWH reduced the incidence of PE (RR = 0.67; 95% CI = 0.50-0.90; P = 0.009) in high risk pregnant women without thrombophilia. Subgroup analysis found that the prophylactic effect of LMWH was only significant in studies using low-dose aspirin (LDA) as the primary intervention. The combination of LMWH and LDA was also effective for the prevention of preterm birth and fetal growth restriction, but had no effect on the incidence of placenta abruption.
CONCLUSIONS: For women at high risk of developing preeclampsia without thrombophilia, the combination of LMWH and low-dose aspirin is effective for the prevention of preeclampsia, preterm birth and fetal growth restriction and is superior to LDA alone.