Meta-analysis on aspirin combined with low-molecular-weight heparin for improving the live birth rate in patients with antiphospholipid syndrome and its correlation with d-dimer levels

• Published in: Medicine (Baltimore) 2021-06, Vol.100 (25), p.e26264-e26264
• Main Authors: Shi, Ting, Gu, Zhong-Deng, Diao, Qi-zhi
• Format: Article
• Language: English
• Subjects: Abortion, Habitual - blood; Abortion, Habitual - immunology; Abortion, Habitual - prevention & control; Antibodies, Antiphospholipid - blood; Antibodies, Antiphospholipid - immunology; Anticoagulants - administration & dosage; Antiphospholipid Syndrome - blood; Antiphospholipid Syndrome - complications; Antiphospholipid Syndrome - drug therapy; Antiphospholipid Syndrome - immunology; Aspirin - administration & dosage; Biomarkers - blood; Birth Rate; Drug Therapy, Combination - methods; Female; Fibrin Fibrinogen Degradation Products - analysis; Heparin, Low-Molecular-Weight - administration & dosage; Humans; Live Birth; Pregnancy; Pregnancy Complications, Hematologic - blood; Pregnancy Complications, Hematologic - diagnosis; Pregnancy Complications, Hematologic - drug therapy; Pregnancy Complications, Hematologic - immunology; Prognosis; Randomized Controlled Trials as Topic; Systematic Review and Meta-Analysis; Thrombosis - blood; Thrombosis - complications; Thrombosis - drug therapy; Thrombosis - immunology; Treatment Outcome
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000026264

Antiphospholipid antibody syndrome (APS) is a systemic, autoimmune, prothrombotic disease characterized by persistent antiphospholipid antibodies, thrombosis, recurrent abortion, complications during pregnancy, and occasionally thrombocytopenia. At present, there is no consensus on the treatment of this disease. Long-term anticoagulation is recommended in most cases in patients with thrombotic APS. This study aimed to evaluate whether aspirin combined with low-molecular-weight heparin (LMWH) can improve the live birth rate in antiphospholipid syndrome and its correlation with D-dimer. The data were retrieved from the WanFang Data, CBM, VIP, CNKI, the Cochrane Library, PubMed, EMBASE, OVID, and Web of Science databases. We collected data on randomized controlled trials of aspirin combined with LMWH in the treatment of pregnant women with APS. The "Risk of Bias Assessment" tool and the "Jadad Scale" provided by the Cochrane Collaboration were used to evaluate the risk of bias and quality of the collected literature. The risk ratio (RR) and its 95% confidence interval (CI) were determined using Statase-64 software. In this study, a total of 11 studies were included, comprising a total of 2101 patients. The live birth rate in pregnant women with APS was higher on administration of aspirin combined with LMWH than with aspirin alone (RR = 1.29, 95% CI = 1.22-1.35, P < .001). d-dimer concentration in plasma predicted the live birth rate, which was higher below the baseline than above it (RR = 1.16, 95% CI = 1.09-1.23, P