Antithrombotic therapy for improving maternal or infant health outcomes in women considered at risk of placental dysfunction

• Published in: Cochrane database of systematic reviews 2013-07 (7), p.CD006780
• Main Authors: Dodd, Jodie M, McLeod, Anne, Windrim, Rory C, Kingdom, John
• Format: Article
• Language: English
• Subjects: Aspirin - therapeutic use; Dipyridamole - therapeutic use; Eclampsia - prevention & control; Female; Fibrinolytic Agents - therapeutic use; Heparin - therapeutic use; Humans; Infant; Infant, Low Birth Weight; Infant, Newborn; Placenta Diseases - prevention & control; Pre-Eclampsia - drug therapy; Pre-Eclampsia - prevention & control; Pregnancy; Randomized Controlled Trials as Topic; Thrombosis - prevention & control; Trapidil - therapeutic use; Treatment Outcome
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.CD006780.pub3

Pregnancy complications such as pre-eclampsia and eclampsia, intrauterine growth restriction and placental abruption are thought to have a common origin related to abnormalities in the development and function of the placenta. To compare, using the best available evidence, the benefits and harms of antenatal antithrombotic therapy to improve maternal or infant health outcomes in women considered at risk of placental dysfunction, when compared with other treatments, placebo or no treatment. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 July 2012). Randomised controlled trials comparing antenatal antithrombotic therapy (either alone or in combination with other agents) with placebo or no treatment, or any other treatment in the antenatal period to improve maternal or infant health outcomes in women considered at risk of placental dysfunction. Two review authors evaluated trials under consideration for appropriateness for inclusion and methodological quality without consideration of their results according to the prestated eligibility criteria. We used a fixed-effect meta-analysis for combining study data if the trials were judged to be sufficiently similar. We investigated heterogeneity by calculating I² statistic, and if this indicated a high level of heterogeneity among the trials included, we used a random-effects model. Our search strategy identified 18 reports of 14 studies for consideration. The original review included five studies (484 women) which met the inclusion criteria, with a further five studies included in the updated review, involving an additional 655 women. The overall quality of the included trials was considered fair to good.Nine studies compared heparin (alone or in combination with dipyridamole or low-dose aspirin) with no treatment; and one compared trapidil (triazolopyrimidine).While this review identified the use of heparin to be associated with a statistically significant reduction in risk of perinatal mortality (six studies; 653 women; risk ratio (RR) 0.40; 95% confidence intervals (CI) 0.20 to 0.78), preterm birth before 34 (three studies; 494 women; RR 0.46; 95% CI 0.29 to 0.73) and 37 (five studies; 621 women; RR 0.72; 95% CI 0.58 to 0.90) weeks' gestation, and infant birthweight below the 10th centile for gestational age (seven studies; 710 infants; RR 0.41; 95% CI 0.27 to 0.61), there is a lack of reliable information available related to clinically relevant, serious adverse infant health outc