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Meta-Analysis
. 2021 Mar 29;3(3):CD001689.
doi: 10.1002/14651858.CD001689.pub4.

Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period

Philippa Middleton  1 , Emily Shepherd  2 , Judith C Gomersall  3
Affiliations
Meta-Analysis

Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period

Philippa Middleton et al. Cochrane Database Syst Rev. .

Abstract

Background: Venous thromboembolism (VTE), although rare, is a major cause of maternal mortality and morbidity. Some women are at increased risk of VTE during pregnancy and the early postnatal period (e.g. caesarean section, family history of VTE, or thrombophilia), and so prophylaxis may be considered. As some methods of prophylaxis carry risks of adverse effects, and risk of VTE is often low, benefits of thromboprophylaxis may be outweighed by harms.

Objectives: To assess the effects of thromboprophylaxis during pregnancy and the early postnatal period on the risk of venous thromboembolic disease and adverse effects in women at increased risk of VTE.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (18 October 2019). In addition, we searched ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) for unpublished, planned and ongoing trial reports (18 October 2019).

Selection criteria: Randomised trials comparing one method of thromboprophylaxis with placebo or no treatment, or two (or more) methods of thromboprophylaxis.

Data collection and analysis: At least two review authors assessed trial eligibility, extracted data, assessed risk of bias, and judged certainty of evidence for selected critical outcomes (using GRADE). We conducted fixed-effect meta-analysis and reported data (all dichotomous) as summary risk ratios (RRs) with 95% confidence intervals (CIs).

Main results: Twenty-nine trials (involving 3839 women), overall at moderate to high risk of bias were included. Trials were conducted across the antenatal, peripartum and postnatal periods, with most in high-income countries. Interventions included types and regimens of heparin (low molecular weight heparin (LMWH) and unfractionated heparin (UFH)), hydroxyethyl starch (HES), and compression stockings or devices. Data were limited due to a small number of trials in comparisons and/or few or no events reported. All critical outcomes (assessed for comparisons of heparin versus no treatment/placebo, and LMWH versus UFH) were considered to have very low-certainty evidence, downgraded mainly for study limitations and imprecise effect estimates. Maternal death was not reported in most studies. Antenatal (± postnatal) prophylaxis For the primary outcomes symptomatic thromboembolic events pulmonary embolism (PE) and/or deep vein thrombosis (DVT), and the critical outcome of adverse effects sufficient to stop treatment, the evidence was very uncertain. Symptomatic thromboembolic events: - heparin versus no treatment/placebo (RR 0.39; 95% CI 0.08 to 1.98; 4 trials, 476 women; very low-certainty evidence); - LMWH versus UFH (RR 0.47; 95% CI 0.09 to 2.49; 4 trials, 404 women; very low-certainty evidence); Symptomatic PE: - heparin versus no treatment/placebo (RR 0.33; 95% CI 0.02 to 7.14; 3 trials, 187 women; very low-certainty evidence); - LMWH versus UFH (no events; 3 trials, 287 women); Symptomatic DVT: - heparin versus no treatment/placebo (RR 0.33; 95% CI 0.04 to 3.10; 4 trials, 227 women; very low-certainty evidence); - LMWH versus UFH (no events; 3 trials, 287 women); Adverse effects sufficient to stop treatment: - heparin versus no treatment/placebo (RR 0.49; 95% CI 0.05 to 5.31; 1 trial, 139 women; very low-certainty evidence); - LMWH versus UFH (RR 0.07; 95% CI 0.01 to 0.54; 2 trials, 226 women; very low-certainty evidence). Peripartum/postnatal prophylaxis Vaginal or caesarean birth When UFH and no treatment were compared, the effects on symptomatic thromboembolic events (RR 0.16; 95% CI 0.02 to 1.36; 1 trial, 210 women; very low-certainty evidence), symptomatic PE (RR 0.16; 95% CI 0.01 to 3.34; 1 trial, 210 women; very low-certainty evidence), and symptomatic DVT (RR 0.27; 95% CI 0.03 to 2.55; 1 trial, 210 women; very low-certainty evidence) were very uncertain. Maternal death and adverse effects sufficient to stop treatment were not reported. Caesarean birth Symptomatic thromboembolic events: - heparin versus no treatment/placebo (RR 1.30; 95% CI 0.39 to 4.27; 4 trials, 840 women; very low-certainty evidence); - LMWH versus UFH (RR 0.33; 95% CI 0.01 to 7.99; 3 trials, 217 women; very low-certainty evidence); Symptomatic PE: - heparin versus no treatment/placebo (RR 1.10; 95% CI 0.25 to 4.87; 4 trials, 840 women; very low-certainty evidence); - LMWH versus UFH (no events; 3 trials, 217 women); Symptomatic DVT: - heparin versus no treatment/placebo (RR 1.30; 95% CI 0.24 to 6.94; 5 trials, 1140 women; very low-certainty evidence); LMWH versus UFH (RR 0.33; 95% CI 0.01 to 7.99; 3 trials, 217 women; very low-certainty evidence); Maternal death: - heparin versus placebo (no events, 1 trial, 300 women); Adverse effects sufficient to stop treatment: - heparin versus placebo (no events; 1 trial, 140 women). Postnatal prophylaxis No events were reported for LMWH versus no treatment/placebo for: symptomatic thromboembolic events, symptomatic PE and symptomatic DVT (all 2 trials, 58 women), or maternal death (1 trial, 24 women). Adverse effects sufficient to stop treatment were not reported. We were unable to conduct subgroup analyses due to lack of data. Sensitivity analysis including the nine studies at low risk of bias did not impact overall findings.

Authors' conclusions: The evidence is very uncertain about benefits and harms of VTE thromboprophylaxis in women during pregnancy and the early postnatal period at increased risk of VTE. Further high-quality very large-scale randomised trials are needed to determine effects of currently used treatments in women with different VTE risk factors. As sufficiently large definitive trials are unlikely to be funded, secondary data analyses based on high-quality registry data are important.

Trial registration: ClinicalTrials.gov NCT01321788 NCT00967382 NCT01274637 NCT01068795 NCT02070237 NCT00356434 NCT01588171 NCT00400387 NCT03659708 NCT00225108 NCT00878826 NCT01019655 NCT01828697 NCT04153760.

PubMed Disclaimer

Conflict of interest statement

Judith Gomersall: none known.

Philippa Middleton: none known.

Emily Shepherd: none known.

Figures

1
1
Study flow diagram
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
1.1
1.1. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 1: Symptomatic thromboembolic events
1.2
1.2. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 2: Symptomatic pulmonary embolism
1.3
1.3. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 3: Symptomatic deep vein thrombosis
1.4
1.4. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 4: Blood transfusion
1.5
1.5. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 5: Bleeding episodes
1.6
1.6. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 6: Serious wound complications
1.7
1.7. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 7: Adverse effects sufficient to stop treatment
1.8
1.8. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 8: Adverse effects not sufficient to stop treatment
1.9
1.9. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 9: Symptomatic osteoporosis
1.10
1.10. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 10: Fetal loss
1.11
1.11. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 11: Thrombocytopenia
1.12
1.12. Analysis
Comparison 1: Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 12: Fetal anomalies
2.1
2.1. Analysis
Comparison 2: Antenatal (± postnatal) prophylaxis: LMWH versus UFH, Outcome 1: Symptomatic thromboembolic events
2.2
2.2. Analysis
Comparison 2: Antenatal (± postnatal) prophylaxis: LMWH versus UFH, Outcome 2: Symptomatic pulmonary embolism
2.3
2.3. Analysis
Comparison 2: Antenatal (± postnatal) prophylaxis: LMWH versus UFH, Outcome 3: Symptomatic deep vein thrombosis
2.4
2.4. Analysis
Comparison 2: Antenatal (± postnatal) prophylaxis: LMWH versus UFH, Outcome 4: Blood transfusion
2.5
2.5. Analysis
Comparison 2: Antenatal (± postnatal) prophylaxis: LMWH versus UFH, Outcome 5: Bleeding episodes
2.6
2.6. Analysis
Comparison 2: Antenatal (± postnatal) prophylaxis: LMWH versus UFH, Outcome 6: Adverse effects sufficient to stop treatment
2.7
2.7. Analysis
Comparison 2: Antenatal (± postnatal) prophylaxis: LMWH versus UFH, Outcome 7: Adverse effects not sufficient to stop treatment
2.8
2.8. Analysis
Comparison 2: Antenatal (± postnatal) prophylaxis: LMWH versus UFH, Outcome 8: Symptomatic osteoporosis
2.9
2.9. Analysis
Comparison 2: Antenatal (± postnatal) prophylaxis: LMWH versus UFH, Outcome 9: Fetal loss
2.10
2.10. Analysis
Comparison 2: Antenatal (± postnatal) prophylaxis: LMWH versus UFH, Outcome 10: Thrombocytopenia
3.1
3.1. Analysis
Comparison 3: Antenatal (±postnatal) prophylaxis: Adjusted‐dose versus fixed‐dose LMWH, Outcome 1: Symptomatic thromboembolic events
3.2
3.2. Analysis
Comparison 3: Antenatal (±postnatal) prophylaxis: Adjusted‐dose versus fixed‐dose LMWH, Outcome 2: Symptomatic pulmonary embolism
3.3
3.3. Analysis
Comparison 3: Antenatal (±postnatal) prophylaxis: Adjusted‐dose versus fixed‐dose LMWH, Outcome 3: Symptomatic deep vein thrombosis
3.4
3.4. Analysis
Comparison 3: Antenatal (±postnatal) prophylaxis: Adjusted‐dose versus fixed‐dose LMWH, Outcome 4: Asymptomatic thromboembolic events
3.5
3.5. Analysis
Comparison 3: Antenatal (±postnatal) prophylaxis: Adjusted‐dose versus fixed‐dose LMWH, Outcome 5: Bleeding episodes
3.6
3.6. Analysis
Comparison 3: Antenatal (±postnatal) prophylaxis: Adjusted‐dose versus fixed‐dose LMWH, Outcome 6: Adverse effects sufficient to stop treatment
3.7
3.7. Analysis
Comparison 3: Antenatal (±postnatal) prophylaxis: Adjusted‐dose versus fixed‐dose LMWH, Outcome 7: Adverse effects not sufficient to stop treatment
3.8
3.8. Analysis
Comparison 3: Antenatal (±postnatal) prophylaxis: Adjusted‐dose versus fixed‐dose LMWH, Outcome 8: Fetal loss
3.9
3.9. Analysis
Comparison 3: Antenatal (±postnatal) prophylaxis: Adjusted‐dose versus fixed‐dose LMWH, Outcome 9: Thrombocytopenia
4.1
4.1. Analysis
Comparison 4: Antenatal (± postnatal) prophylaxis: Compression stockings versus none, Outcome 1: Symptomatic deep vein thrombosis
4.2
4.2. Analysis
Comparison 4: Antenatal (± postnatal) prophylaxis: Compression stockings versus none, Outcome 2: Adverse effects not sufficient to stop treatment
5.1
5.1. Analysis
Comparison 5: Peripartum/postnatal prophylaxis: UFH versus no treatment, Outcome 1: Symptomatic thromboembolic events
5.2
5.2. Analysis
Comparison 5: Peripartum/postnatal prophylaxis: UFH versus no treatment, Outcome 2: Symptomatic pulmonary embolism
5.3
5.3. Analysis
Comparison 5: Peripartum/postnatal prophylaxis: UFH versus no treatment, Outcome 3: Symptomatic deep vein thrombosis
6.1
6.1. Analysis
Comparison 6: Peripartum/postnatal prophylaxis (caesarean): Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 1: Maternal death
6.2
6.2. Analysis
Comparison 6: Peripartum/postnatal prophylaxis (caesarean): Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 2: Symptomatic thromboembolic events
6.3
6.3. Analysis
Comparison 6: Peripartum/postnatal prophylaxis (caesarean): Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 3: Symptomatic pulmonary embolism
6.4
6.4. Analysis
Comparison 6: Peripartum/postnatal prophylaxis (caesarean): Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 4: Symptomatic deep vein thrombosis
6.5
6.5. Analysis
Comparison 6: Peripartum/postnatal prophylaxis (caesarean): Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 5: Blood transfusion
6.6
6.6. Analysis
Comparison 6: Peripartum/postnatal prophylaxis (caesarean): Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 6: Bleeding episodes (variously defined)
6.7
6.7. Analysis
Comparison 6: Peripartum/postnatal prophylaxis (caesarean): Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 7: Serious wound complications
6.8
6.8. Analysis
Comparison 6: Peripartum/postnatal prophylaxis (caesarean): Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 8: Adverse effects sufficient to stop treatment
6.9
6.9. Analysis
Comparison 6: Peripartum/postnatal prophylaxis (caesarean): Heparin (LMWH or UFH) versus no treatment/placebo, Outcome 9: Adverse effects not sufficient to stop treatment
7.1
7.1. Analysis
Comparison 7: Peripartum/postnatal prophylaxis (caesarean): HES versus UFH, Outcome 1: Asymptomatic thromboembolic events
7.2
7.2. Analysis
Comparison 7: Peripartum/postnatal prophylaxis (caesarean): HES versus UFH, Outcome 2: Blood transfusion
7.3
7.3. Analysis
Comparison 7: Peripartum/postnatal prophylaxis (caesarean): HES versus UFH, Outcome 3: Bleeding episodes
7.4
7.4. Analysis
Comparison 7: Peripartum/postnatal prophylaxis (caesarean): HES versus UFH, Outcome 4: Serious wound complications
8.1
8.1. Analysis
Comparison 8: Peripartum/postnatal prophylaxis (caesarean): LMWH versus UFH, Outcome 1: Symptomatic thromboembolic events
8.2
8.2. Analysis
Comparison 8: Peripartum/postnatal prophylaxis (caesarean): LMWH versus UFH, Outcome 2: Symptomatic pulmonary embolism
8.3
8.3. Analysis
Comparison 8: Peripartum/postnatal prophylaxis (caesarean): LMWH versus UFH, Outcome 3: Symptomatic deep vein thrombosis
8.4
8.4. Analysis
Comparison 8: Peripartum/postnatal prophylaxis (caesarean): LMWH versus UFH, Outcome 4: Bleeding episodes
8.5
8.5. Analysis
Comparison 8: Peripartum/postnatal prophylaxis (caesarean): LMWH versus UFH, Outcome 5: Adverse effects not sufficient to stop treatment
8.6
8.6. Analysis
Comparison 8: Peripartum/postnatal prophylaxis (caesarean): LMWH versus UFH, Outcome 6: Thrombocytopenia
9.1
9.1. Analysis
Comparison 9: Peripartum/postnatal prophylaxis (caesarean): 5‐day versus 10‐day LMWH, Outcome 1: Maternal death
9.2
9.2. Analysis
Comparison 9: Peripartum/postnatal prophylaxis (caesarean): 5‐day versus 10‐day LMWH, Outcome 2: Symptomatic thromboembolic events
9.3
9.3. Analysis
Comparison 9: Peripartum/postnatal prophylaxis (caesarean): 5‐day versus 10‐day LMWH, Outcome 3: Symptomatic pulmonary embolism
9.4
9.4. Analysis
Comparison 9: Peripartum/postnatal prophylaxis (caesarean): 5‐day versus 10‐day LMWH, Outcome 4: Symptomatic deep vein thrombosis
9.5
9.5. Analysis
Comparison 9: Peripartum/postnatal prophylaxis (caesarean): 5‐day versus 10‐day LMWH, Outcome 5: Bleeding episodes
9.6
9.6. Analysis
Comparison 9: Peripartum/postnatal prophylaxis (caesarean): 5‐day versus 10‐day LMWH, Outcome 6: Serious wound complications
9.7
9.7. Analysis
Comparison 9: Peripartum/postnatal prophylaxis (caesarean): 5‐day versus 10‐day LMWH, Outcome 7: Thrombocytopenia
10.1
10.1. Analysis
Comparison 10: Peripartum/postnatal prophylaxis (caesarean): Weight‐based versus fixed‐dose LMWH, Outcome 1: Symptomatic thromboembolic events
10.2
10.2. Analysis
Comparison 10: Peripartum/postnatal prophylaxis (caesarean): Weight‐based versus fixed‐dose LMWH, Outcome 2: Symptomatic pulmonary embolism
10.3
10.3. Analysis
Comparison 10: Peripartum/postnatal prophylaxis (caesarean): Weight‐based versus fixed‐dose LMWH, Outcome 3: Symptomatic deep vein thrombosis
10.4
10.4. Analysis
Comparison 10: Peripartum/postnatal prophylaxis (caesarean): Weight‐based versus fixed‐dose LMWH, Outcome 4: Blood transfusion
10.5
10.5. Analysis
Comparison 10: Peripartum/postnatal prophylaxis (caesarean): Weight‐based versus fixed‐dose LMWH, Outcome 5: Serious wound complications
11.1
11.1. Analysis
Comparison 11: Peripartum/postnatal prophylaxis (caesarean): LMWH versus LMWH (different types), Outcome 1: Symptomatic thromboembolic events
11.2
11.2. Analysis
Comparison 11: Peripartum/postnatal prophylaxis (caesarean): LMWH versus LMWH (different types), Outcome 2: Symptomatic pulmonary embolism
11.3
11.3. Analysis
Comparison 11: Peripartum/postnatal prophylaxis (caesarean): LMWH versus LMWH (different types), Outcome 3: Symptomatic deep vein thrombosis
11.4
11.4. Analysis
Comparison 11: Peripartum/postnatal prophylaxis (caesarean): LMWH versus LMWH (different types), Outcome 4: Bleeding episodes (excessive bruising)
11.5
11.5. Analysis
Comparison 11: Peripartum/postnatal prophylaxis (caesarean): LMWH versus LMWH (different types), Outcome 5: Adverse effects not sufficient to stop treatment
12.1
12.1. Analysis
Comparison 12: Peripartum/postnatal prophylaxis (caesarean): Compression devices versus bed rest, Outcome 1: Symptomatic thromboembolic events
12.2
12.2. Analysis
Comparison 12: Peripartum/postnatal prophylaxis (caesarean): Compression devices versus bed rest, Outcome 2: Symptomatic pulmonary embolism
12.3
12.3. Analysis
Comparison 12: Peripartum/postnatal prophylaxis (caesarean): Compression devices versus bed rest, Outcome 3: Symptomatic deep vein thrombosis
12.4
12.4. Analysis
Comparison 12: Peripartum/postnatal prophylaxis (caesarean): Compression devices versus bed rest, Outcome 4: Blood transfusion
13.1
13.1. Analysis
Comparison 13: Postnatal prophylaxis: LMWH versus no treatment/placebo, Outcome 1: Maternal death
13.2
13.2. Analysis
Comparison 13: Postnatal prophylaxis: LMWH versus no treatment/placebo, Outcome 2: Symptomatic thromboembolic events
13.3
13.3. Analysis
Comparison 13: Postnatal prophylaxis: LMWH versus no treatment/placebo, Outcome 3: Symptomatic pulmonary embolism
13.4
13.4. Analysis
Comparison 13: Postnatal prophylaxis: LMWH versus no treatment/placebo, Outcome 4: Symptomatic deep vein thrombosis
13.5
13.5. Analysis
Comparison 13: Postnatal prophylaxis: LMWH versus no treatment/placebo, Outcome 5: Asymptomatic thromboembolic events
13.6
13.6. Analysis
Comparison 13: Postnatal prophylaxis: LMWH versus no treatment/placebo, Outcome 6: Bleeding episodes
13.7
13.7. Analysis
Comparison 13: Postnatal prophylaxis: LMWH versus no treatment/placebo, Outcome 7: Adverse effects not sufficient to stop treatment
13.8
13.8. Analysis
Comparison 13: Postnatal prophylaxis: LMWH versus no treatment/placebo, Outcome 8: Thrombocytopenia
14.1
14.1. Analysis
Comparison 14: Sensitivity analysis: antenatal (± postnatal) prophylaxis with heparin versus no treatment/placebo, Outcome 1: Symptomatic thromboembolic events
14.2
14.2. Analysis
Comparison 14: Sensitivity analysis: antenatal (± postnatal) prophylaxis with heparin versus no treatment/placebo, Outcome 2: Symptomatic pulmonary embolism
14.3
14.3. Analysis
Comparison 14: Sensitivity analysis: antenatal (± postnatal) prophylaxis with heparin versus no treatment/placebo, Outcome 3: Symptomatic deep vein thrombosis
15.1
15.1. Analysis
Comparison 15: Sensitivity analysis: antenatal (± postnatal) prophylaxis with LMWH versus UFH, Outcome 1: Symptomatic thromboembolic events
15.2
15.2. Analysis
Comparison 15: Sensitivity analysis: antenatal (± postnatal) prophylaxis with LMWH versus UFH, Outcome 2: Symptomatic pulmonary embolism
15.3
15.3. Analysis
Comparison 15: Sensitivity analysis: antenatal (± postnatal) prophylaxis with LMWH versus UFH, Outcome 3: Symptomatic deep vein thrombosis
16.1
16.1. Analysis
Comparison 16: Sensitivity analysis: peripartum/postnatal prophylaxis (caesarean) with LMWH versus no treatment/placebo, Outcome 1: Symptomatic thromboembolic events
16.2
16.2. Analysis
Comparison 16: Sensitivity analysis: peripartum/postnatal prophylaxis (caesarean) with LMWH versus no treatment/placebo, Outcome 2: Symptomatic pulmonary embolism
16.3
16.3. Analysis
Comparison 16: Sensitivity analysis: peripartum/postnatal prophylaxis (caesarean) with LMWH versus no treatment/placebo, Outcome 3: Symptomatic deep vein thrombosis
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References

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    1. Brocklehurst P, Thromboprophylaxis in Pregnancy Advisory Group. Thromboprophylaxis in pregnancy trials: apple, plum and peach. British Journal of Obstetrics and Gynaecology 1998;105(Suppl 17):53.
    1. Gates S, Brocklehurst P, Ayers S, Bowler U. Thromboprophylaxis and pregnancy: two randomized controlled pilot trials that used low molecular weight heparin. American Journal of Obstetrics and Gynecology 2004;191:1296-303. - PubMed
    1. National Perinatal Epidemiology Unit. The PEACH Study. www.npeu.ox.ac.uk/trials/peach.html (first received 12 January 2001).
Gibson 1998 {published data only}
    1. Gibson JL, Ekevall K, Walker I, Greer IA. Puerperal thromboprophylaxis: comparison of the anti-Xa activity of enoxaparin and unfractionated heparin. British Journal of Obstetrics and Gynaecology 1998;105:795-7. - PubMed
Hamersley 1998 {published data only}
    1. Hamersley S, Landy H. Low molecular weight heparin is associated with less peripartum blood loss than unfractionated heparin [abstract]. American Journal of Obstetrics and Gynecology 1998;178(1 Pt 2):S66.
Heilmann 1991 {published data only}
    1. Heilman L, Heitz R, Koch FU, Ose C. Perioperative thrombosis prophylaxis at the time of caesarean section: results of a randomised prospective comparative study with 6% hydroxyethyl starch 0.62 and low dose heparin [Die perioperative Thromboseprophylaxe beim Kaiserschnitt: Ergebnisse einer randomisierten prospektiven Vergleichsuntersuchung mit 6% Hydroxyathylstarke 0,62 und Low-dose-Heparin]. Zeitschrift fur Geburtshilfe und Perinatologie 1991;195:10-5. - PubMed
Heilmann 2007 {published data only}
    1. Heilmann L, Rath W, Pollow K, Bick RL. The rheological changes after cesarean section: the influence of low molecular weight or unfractionated heparin on the rheological properties of blood. Clinical Hemorheology and Microcirculation 2007;37:211-8. - PubMed
Heller 2016 {published data only}
    1. Heller J, Canner J, Wei Lum Y, Tsuchiya K. Compression stockings during pregnancy: essential or superfluous? A pilot study. Journal of Vascular Surgery: Venous and Lymphatic Disorders 2016;4(1):148.
    1. NCT01793194. Preventing the development of venous insufficiency in pregnant women through use of compression stockings: a randomized pilot study. http://www.clinicaltrials.gov/ct2/show/NCT01793194 (first received 21 May 2013).
Hill 1988 {published and unpublished data}
    1. Hill NC, Hill JG, Sargent JM, Taylor CG, Bush PV. Effect of low dose heparin on blood loss at caesarean section. BMJ 1988;296:505-6. - PMC - PubMed
    1. Hill NC, Hill JG, Sargent JM, Taylor CG, Bush PV. The effect of low dose heparin on blood loss at caesarean section. In: 12th FIGO World Congress of Gynecology and Obstetrics; 1988 October 23-28; Brazil. 1988. - PMC - PubMed
Howell 1983 {published data only}
    1. Howell R, Fidler J, Letsky E, Swiet M. The risks of antenatal subcutaneous heparin prophylaxis: a controlled trial. British Journal of Obstetrics and Gynaecology 1983;90:1124-8. - PubMed
Krauss 1994 {published data only}
    1. Krauss T, Rath W, Dittmer U, Kuhn W. Use of LMW heparin (Fragmin) for the prevention of thromboembolism in obstetrics [Thromboembolieprophylaxe mit niedermolekularen Heparin (Fragmin)in der Geburtshilfe]. Zeitschrift fur Geburtshilfe und Perinatologie 1994;198:120-5. - PubMed
O'Riordan 2008 {published data only}
    1. O'Riordan MN, Horgan R, Arya A, Quinn S, Gaolebale PA, Sarkar RK, et al. Pharmokinetics of low molecular weight heparins in the postpartum period. In: Irish Perinatal Society Annual Meetings; 2008 April 11-12; Cork, Ireland. 2008:10.
Pettila 1999 {published data only}
    1. Pettila V, Kaaja R, Leinonen P, Ekblad U, Kataja M, Ikkala E. Thromboprophylaxis with low molecular weight heparin (dalteparin) in pregnancy. Thrombosis Research 1999;96:275-82. - PubMed
    1. Pettila V, Leinonen P, Markkola A, Hiilesmaa V, Kaaja R. Postpartum bone mineral density in women treated for thromboprophylaxis with unfractionated heparin or LMW heparin. Thrombosis and Haemostasis 2002;87(2):182-6. - PubMed
Reddick 2014 {published data only}
    1. Reddick KL, Smrtka MP, Grotegut CA, James AH, Brancazio LR, Swamy GK. The effects of intermittent pneumatic compression during cesarean delivery on fibrinolysis. American Journal of Perinatology 2014;31(9):735-40. - PubMed
Rodger 2014 {published data only}ISRCTN87441504
    1. Abou-Nassar K, Kovacs MJ, Kahn SR, Wells P, Doucette S, Ramsay T, et al. The effect of dalteparin on coagulation activation during pregnancy in women with thrombophilia. A randomized trial. Thrombosis and Haemostasis 2007;98(1):163-71. - PubMed
    1. Abou-Nassar K, Rodger M, Kovacs MJ, Doucette S, Tim R, Kahn S, et al. The effect of dalteparin on coagulation activation during pregnancy in women with thrombophilia: a randomised trial. Blood 2006;108(11 Pt 1):262. - PubMed
    1. NCT00967382. Thrombophilia in pregnancy prophylaxis study (TIPPS). http://www.clinicaltrials.gov/ct2/show/NCT00967382 (first received 30 January 2013).
    1. Rodger M, Hague WM, Kingdom J, Kahn SR, Karovitch A, Wells PS, et al. The Thrombophilia in Pregnancy Prophylaxis Study (TIPPS): a multi-national randomized trial of dalteparin vs. no dalteparin to prevent pregnancy complications in pregnant thrombophilic women. Journal of Thrombosis and Haemostasis 2013;11(Suppl 2):78.
    1. Rodger MA, Hague WM, Kingdom J, Kahn SR, Karovitch A, Sermer M, et al. Antepartum dalteparin versus no antepartum dalteparin for the prevention of pregnancy complications in pregnant women with thrombophilia (TIPPS): a multinational open-label randomised trial. Lancet 2014;384:1673-83. - PubMed
Rodger 2015 {published data only}
    1. NCT01274637. PROSPER: Postpartum prophylaxis for PE randomized control trial pilot. http://clinicaltrials.gov/show/NCT01274637 (first received 15 February 2011).
    1. Rodger MA, Phillips P, Kahn SR, James AH, Konkle BA. Low-molecular-weight heparin to prevent postpartum venous thromboembolism. A pilot randomised placebo-controlled trial. Thrombosis and Haemostasis 2015;113(1):212-6. - PubMed
Rodger 2016 {published data only}
    1. NCT01274637. PROSPER: Postpartum prophylaxis for PE randomized control trial pilot. http://clinicaltrials.gov/show/NCT01274637 (first received 15 February 2011).
    1. Rodger MA, Phillips P, Kahn SR, Bates S, McDonald S, Khurana R, et al. Low molecular weight heparin to prevent postpartum venous thromboembolism. A pilot study to assess the feasibility of a randomized open-label trial. Thrombosis Research 2016;142:17-20. - PubMed
Salim 2016 {published data only}
    1. Garmi G, Okopnik M, Zuarez-Easton S, Zafran N, Romano S, Salim R. Placental findings following adjusting enoxaparin dosage according to anti-fxa levels in thrombophilic women. A randomized controlled trial. American Journal of Obstetrics and Gynecology 2017;216(1 Suppl 1):S457.
    1. Garmi G, Zafran N, Okopnik M, Gavish I, Romano S, Salim R. Placental pathological findings following adjusting enoxaparin dosage in thrombophilic women: secondary analysis of a randomized controlled trial. Thrombosis and Haemostasis 2019;119(1):87-91. - PubMed
    1. NCT01068795. Dose adjusting enoxaparin thromboprophylaxis dosage according to anti-factor Xa plasma levels improve pregnancy outcome. http://clinicaltrials.gov/show/NCT01068795 (first received 18 June 2013).
    1. Salim R, Nachum Z, Gavish I, Romano S, Braverman M, Garmi G. Adjusting enoxaparin dosage according to anti-FXa levels and pregnancy outcome in thrombophilic women. A randomised controlled trial. Thrombosis and Haemostasis 2016;116(4):687-95. - PubMed
Segal 1975 {published data only}
    1. Segal S, Sadovsky E, Weinstein D, Polishuk WZ. Prevention of postpartum venous thrombosis with low doses of heparin. European Journal of Obstetrics and Gynecology and Reproductive Biology 1975;5:273-6. - PubMed
Stephenson 2016 {published data only}
    1. NCT02070237. Comparing anti-XA levels in post-cesarean patients undergoing enoxaparin thromboprophylaxis. https://clinicaltrials.gov/ct2/show/NCT02070237 (first received 25 February 2014).
    1. Stephenson M, Serra A, Neeper J, Caballero D, McNulty J. Comparing anti-Xa levels in women with body mass index >/=35 post cesarean delivery undergoing enoxaparin thromboprophylaxis with weight-based dosing twice daily versus fixed dose 40 mg daily: a randomized, controlled trial. American Journal of Obstetrics and Gynecology 2015;212(1 Suppl 1):S18.
    1. Stephenson ML, Serra AE, Neeper JM, Caballero DC, McNulty J. A randomized controlled trial of differing doses of postcesarean enoxaparin thromboprophylaxis in obese women. Journal of Perinatology 2016;36(2):95-9. - PubMed
van Hoorn 2016 {published data only}ISRCTN87325378
    1. Hoorn M, Hague WM, Pampus M, Bezemer D, de Vries J for the FRUIT investigators. Low-molecular-weight heparin and aspirin in the prevention of recurrent early-onset pre-eclampsia in women with antiphospholipid antibodies: the FRUIT-RCT. European Journal of Obstetrics & Gynecology and Reproductive Biology 2016;197:168-73. - PubMed
Welti 1981 {published data only}
    1. Welti H. Prevention of thromboembolism by physiotherapy with and without low dose heparin in gynecology and obstetrics. Results of a controlled, randomized multicenter study [Prophylaxie thrombo-embolique par physiotherapie avec et sans heparine a faibles doses en gynecologie-obstetrique]. Revue Medicale de la Suisse Romande 1981;101(11):925-34. - PubMed

References to studies excluded from this review

Aina 2006 {published data only}
    1. Aina A, NCT00356434. Study of patient compliance and comfort using sequential compression devices and foot pumps for DVT prevention. https://clinicaltrials.gov/ct2/show/results/NCT00356434 (first received 26 July 2006).
Alalaf 2015 {published data only}
    1. Alalaf A, NCT01588171. Bemiparin versus enoxaparin as thromboprophylaxis following vaginal and abdominal deliveries: a prospective clinical trial. https://clinicaltrials.gov/ct2/show/NCT01588171 (first received 30 April 2012). - PMC - PubMed
    1. Alalaf SK, Jawad RK, Muhammad PR, Ali MS, Al Tawil NG. Bemiparin versus enoxaparin as thromboprophylaxis following vaginal and abdominal deliveries: a prospective clinical trial. BMC Pregnancy & Childbirth 2015;15:72. - PMC - PubMed
Badawy 2008 {published data only}
    1. Badawy AM, Khiary M, Sherif LS, Hassan M, Ragab A, Abdelall I. Low-molecular weight heparin in patients with recurrent early miscarriages of unknown aetiology. Journal of Obstetrics and Gynaecology 2008;28(3):280-4. - PubMed
Blomback 1998 {published data only}
    1. Blomback M, Bremme K, Hellgren M, Lindberg H. A pharmacokinetic study of dalteparin (Fragmin) during late pregnancy. Blood Coagulation and Fibrinolysis 1998;9:343-50. - PubMed
Brenner 2005 {published data only}
    1. Brenner B, Bar J, Ellis M, Yarom I, Yohai D, Samueloff A, et al. Effects of enoxaparin on late pregnancy complications and neonatal outcome in women with recurrent pregnancy loss and thrombophilia: results from the live-enox study. Fertility and Sterility 2005;84(3):770-3. - PubMed
    1. Brenner B, Hoffman R, Carp H, Dulitsky M, Samueloff A, Yohai D, et al. Enoxaparin treatment improves the gestational outcome of pregnant women with thrombophilia and recurrent pregnancy loss: the LIVE-ENOX study [abstract]. Blood 2003;102(11):16a.
    1. Brenner B, Hoffman R, Carp H, Dulitsky M, Samueloff A, Yohal D, et al. Efficacy and safety of two doses of enoxaparin in pregnant women with thrombophilia and recurrent pregnancy loss: the LIVE-ENOX study [abstract]. Journal of Thrombosis and Haemostasis 2003;1(Suppl 1):OC084. - PubMed
    1. Brenner B, Hoffman R, Carp H, Dulitsky M, Younis J, LIVE-ENOX investigators. Efficacy and safety of two doses of enoxaparin in women with thrombophilia and recurrent pregnancy loss: the LIVE-ENOX study. Journal of Thrombosis and Haemostasis 2005;3:227-9. - PubMed
    1. Brenner B, for the LIVE-ENOX Investigators. Efficacy and safety of two doses of enoxaparin in pregnant women with thrombophilia and recurrent pregnancy loss. The LIVE-ENOX study [abstract]. Blood 2002;100(11 Pt 1):702a. - PubMed
de Jong 2015 {published data only}
    1. Jong PG, Quenby S, Bloemenkamp KW, Braams-Lisman BA, Bruin JP, Coomarasamy A, et al. ALIFE2 study: low-molecular-weight heparin for women with recurrent miscarriage and inherited thrombophilia - study protocol for a randomized controlled trial. Trials 2015;16(1):208. - PMC - PubMed
Dendrinos 2007 {published data only}
    1. Dendrinos S, Kalogirou I, Makrakis E, Theodoridis T, Mahmound EA, Christopoulou-Cokkinou V, et al. Safety and effectiveness of tinzaparin sodium in the management of recurrent pregnancy loss. Clinical and Experimental Obstetrics and Gynecology 2007;34(3):143-5. - PubMed
Farquharson 2002 {published data only}
    1. Farquharson RG, Quenby S, Greaves M. Antiphospholipid syndrome in pregnancy: a randomized, controlled trial of treatment. Obstetrics and Gynecology 2002;100(3):408-13. - PubMed
Giancotti 2012 {published data only}
    1. Chistolini A, Torelli F, Giancotti A, Pignoloni P, Muto B, Cosimo C, et al. Recurrent fetal loss: prospective evaluation of the efficacy of three different thromboprophylaxis regimens: aspirin versus low molecular weight heparin versus low molecular weight heparin plus aspirin [abstract]. Hematology Journal 2006;91(Suppl 1):146.
    1. Giancotti A, Torre RL, Spagnuolo A, D'Ambrosio V, Cerekja A, Piazze J, et al. Efficacy of three different antithrombotic regimens on pregnancy outcome in pregnant women affected by recurrent pregnancy loss. Journal of Maternal-Fetal and Neonatal Medicine 2012;25(7):1191-4. - PubMed
Gris 2010 {published data only}
    1. Gris JC, Chauleur C, Faillie JL, Baer G, Mares P, Fabbro-Peray P, et al. Enoxaparin for the secondary prevention of placental vascular complications in women with abruptio placentae: the pilot randomised controlled NOH-AP trial. Thrombosis and Haemostasis 2010;104(4):771-9. - PubMed
Gris 2011 {published data only}
    1. Gris JC, Chauleur C, Mares P, Nouvellon E, Mercier E, Bouvier S, et al. Enoxaparin for the secondary prevention of placental complications in women with previous severe pre-eclampsia: the pilot randomised controlled NOH-PE study. Journal of Thrombosis and Haemostasis : JTH 2011;9(Suppl 2):753.
    1. Gris JC, Chauleur C, Molinari N, Mares P, Fabbro-Peray P, Quere I, et al. Addition of enoxaparin to aspirin for the secondary prevention of placental vascular complications in women with severe pre-eclampsia: the pilot randomised controlled NOH-PE trial. Thrombosis and Haemostasis 2011;106(6):1053-61. - PubMed
Guven 2014 {published data only}
    1. Guven D, Bakay K, Kocak I, Ozdemir A. Effectiveness of bemiparin sodium for preventing pregnancy loss in patients with MTHFR C677T mutation and habitual abortus. Open Journal of Obstetrics and Gynecology 2014;4:930-4.
Harenberg 1993 {published data only}
    1. Harenberg J, Schneider D, Heilmann L, Wolf H. Lack of anti-factor Xa activity in umbilical cord vein samples after subcutaneous administration of heparin or low molecular mass heparin in pregnant women. Haemostasis 1993;23:314-20. - PubMed
Kaandorp 2010 {published data only}
    1. Kaandorp SP, Goddijn M, Post JA, Hutten BA, Verhoeve HR, Hamulyák K, et al. Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. New England Journal of Medicine 2010;362(17):1586-96. - PubMed
    1. Middeldorp S. Aspirin and/or low molecular weight heparin for women with unexplained recurrent miscarriage and/or intra-uterine fetal death. Netherlands Trial Register (http://www.trialregister.nl) (first received 1 November 2005).
Kamin 2008 {published data only}
    1. Kamin G, Rogenhofer N, Pildner v Steinberg S, Neuhoffer A, Seeger S, et al. Therapy with dalteparin for habitual abortion - presentation of the ETHiG II-Studie [Therapie mit Dalteparin bei habitueller Abortneigung - Vorstellung der ETHiG II-Studie]. Geburtshilfe und Frauenheilkunde 2008;68:S51.
    1. Rogenhofer N, Markoff A, Wagner A, Klein H-G, Petroff D, Schleussner E, et al. Lessons from the EThIGII trial: Proper putative benefit assessment of low-molecular-weight heparin treatment in M2/ANXA5 haplotype carriers. Clinical and Applied Thrombosis/Hemostasis 2017;23(1):27-33. - PubMed
    1. Schleussner E, Bohlmann M, Kamin G, Rogenhofer N, Seeger S, Toth B. Low molecular weight heparin for the prevention of habitual abortion - introduction of the multicentre study EThIG2 and discussion of the current data [Niedermolekulares heparin zur pravention habitueller aborte - vorstellung der multizentrischen EThIG2-studie und diskussion der aktuellen datenlage]. Archives of Gynecology and Obstetrics 2012;286(Suppl 1):S220.
    1. Schleussner E, Kamin G, Seeliger G, Rogenhofer N, Toth B. Low-molecular-weight heparin in recurrent pregnancy loss-Results of the ETHIG II study. Thrombosis Research 2013;131(Suppl 1):S73.
Kutteh 1996a {published data only}
    1. Kutteh WH, Ermel LD. A clinical trial for the treatment of antiphospholipid antibody-associated recurrent pregnancy loss with lower dose heparin and aspirin. American Journal of Reproductive Immunology 1996;35:402-7. - PubMed
Kutteh 1996b {published data only}
    1. Kutteh WH. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. American Journal of Obstetrics and Gynecology 1996;174(5):1584-9. - PubMed
Langer 2013 {published data only}
    1. Langer E, Fiedler A, Schleusner E, Schlembach D. Placental volume in women under treatment with recurrent miscarriages. Ultraschall in der Medizin, Supplement 2013;34(Suppl 1):WS_SL6_05.
Laskin 2007 {published data only}
    1. Laskin CA, NCT00564174. A randomized controlled trial comparing low molecular weight heparin and aspirin to aspirin alone in women with unexplained recurrent pregnancy loss. https://clinicaltrials.gov/ct2/show/NCT00564174 (first received 27 November 2007).
    1. Laskin CA, Spitzer KA, Clark CA, Crowther MR, Ginsberg JS, Hawker GA, et al. Low molecular weight heparin and aspirin for recurrent pregnancy loss: results from the randomized, controlled HepASA Trial. Journal of Rheumatology 2009;36(2):279-87. - PubMed
Milic 2018 {published data only}
    1. Milic D, Zivic S, Bogdanovic D, Jovanovic M. Compression stockings in the prevention of venous disorders in pregnancy. Phlebology 2018;33(10):709.
Noble 2005 {published data only}
    1. Noble LS, Kutteh WS, Lashey N, Franklin RD, Herrada J. Antiphospholipid antibodies associated with recurrent pregnancy loss: prospective, multicenter, controlled pilot study comparing treatment with low-molecular-weight heparin versus unfractionated heparin. Fertility and Sterility 2005;83(3):684-90. - PubMed
Pyregov 2012 {published data only}
    1. Pyregov A, Shifman E, Shestakova O, Puchko T, Baranov I. Influence of enoxaparine on serum endotoxin concentration in puerpera after abdominal delivery. British Journal of Anaesthesia 2012;108:ii212-3.
Rai 1997 {published data only}
    1. Cohen H. Randomized trial of aspirin versus aspirin and heparin in pregnant women with the antiphospholipid syndrome. Annales de Medicine Interne 1996;147 Suppl 1:44. - PubMed
    1. Rai R, Cohen H, Dave M, Regan L. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). BMJ 1997;314:253-7. - PMC - PubMed
Ratiu 2009 {published data only}
    1. Ratiu A, Motoc A, Pascut D, Crisan DC, Anca T, Pascut M. Compression and walking compared with bed rest in the treatment of proximal deep venous thrombosis during pregnancy. Revista Medico-Chirurgicala a Societatii de Medici Si Naturalisti Din Iasi 2009;113(3):795-8. - PubMed
Rey 2009 {published data only}
    1. Rey E, Garneau P, David M, Gauthier R, Leduc L, Michon N, et al. Dalteparin for the prevention of recurrence of placental-mediated complications of pregnancy in women without thrombophilia: a pilot randomized controlled trial. Journal of Thrombosis and Haemostasis 2009;7(1):58-64. - PubMed
    1. Rey E. Dalteparin in prevention of recurrence of severe obstetrical complications in women without thrombophilia. Journal of Obstetrics and Gynaecology Canada 2007;29(6 Suppl 1):S46.
Rodger 2017 {published data only}
    1. Rodger M, NCT03100123. A pilot study assessing the feasibility of a randomized controlled trial evaluating aspirin versus low-molecular-weight heparin (lmwh) and aspirin in women with antiphospholipid syndrome and pregnancy loss. https://clinicaltrials.gov/ct2/show/NCT03100123 (first received 4 April 2017).
Samantha 2013 {published data only}
    1. Samantha P, Barillari G, Venturelli U, Turello M. Thromboprophylaxis with two different dosages of lmwh (calcic nadroparin) in pregnant women with thrombophilia: a single center experience. Journal of Thrombosis and Haemostasis 2013;11:96-7.
Schleussner 2015 {published data only}
    1. Schleussner E, Kamin G, Seliger G, Rogenhofer N, Ebner S, Toth B, et al. Low-molecular-weight heparin for women with unexplained recurrent pregnancy loss: a multicenter trial with a minimization randomization scheme. Annals of Internal Medicine 2015;162(9):601-9. - PubMed
Stephenson 2004 {published data only}
    1. Stephenson MD, Ballem PJ, Tsang P, Purkiss S, Ensworth S, Houlihan E, et al. Treatment of antiphospholipid antibody syndrome (aps) in pregnancy: a randomized pilot trial comparing low molecular weight heparin to unfractionated heparin. Journal of Obstetrics and Gynaecology Canada 2004;26(8):729-34. - PubMed
Thaler 2004 {published data only}
    1. Thaler I, Brenner B. Efficacy of enoxaparin for improving pregnancy outcomes and uteroplacental blood flow in women with thrombophilia and recurrent pregnancy loss [abstract]. American Journal of Obstetrics and Gynecology 2004;191(6 Suppl 1):S7.
Tulppala 1997 {published data only}
    1. Tulppala M, Marttunen M, Soderstrom-Anttila V, Foudila T, Ailus K, Palosuo T, et al. Low-dose aspirin in prevention of miscarriage in women with unexplained or autoimmune related recurrent miscarriage: effect of prostacyclin and thromboxane A2 production. Human Reproduction 1997;12(7):1567-72. - PubMed
Visser 2011 {published data only}
    1. Visser J, Ulander V, Bloemenkamp K, Kaaja R. A randomised controlled multicenter study: the effect of enoxaparin and/or aspirin on prevention of recurrent miscarriage in women with or without thrombophilia, HABENOX-study. International Journal of Gynecology and Obstetrics 2009;107(Suppl 2):S371.
    1. Visser J, Ulander VM, Helmerhorst FM, Lampinen K, Morin-Papunen L, Bloemenkamp KW, et al. Thromboprophylaxis for recurrent miscarriage in women with or without thrombophilia - HABENOX*: a randomised multicentre trial. Thrombosis and Haemostasis 2011;105(2):295-301. - PubMed

References to studies awaiting assessment

Abdolvand 2019 {published data only}
    1. Abdolvand M, Aleyasin A, Javadi MR, Solduzian M, Hosseini SH, Ziaei Z, et al. Comparison of efficacy and safety of two different enoxaparin products in prevention of venous thromboembolism following major obstetric-gynecological surgeries: an open-label randomized clinical trial. Iranian Journal of Pharmaceutical Research 2019;18(4):2172-9. [CENTRAL: CN-02074323] [EMBASE: 2003440151] - PMC - PubMed
Dittmer 1991 {published data only}
    1. Dittmer U, Rath W, Schrader J, Zuchner C, Scheler F, Kuhn W. Prevention of deep vein thrombosis (DVT) in pregnancy, after caesarean section and after gynaecological abdominal surgery. A comparison between low molecular weight heparin (LMW) and standard heparin (UFH) [abstract]. Annals of Haematology 1991;62 Suppl 1:A40.
Ganer 2020 {published data only}
    1. Ganer Herman H, Kleiner I, Tairy D, Gonen N, Ben Zvi M, Kovo M, et al. Effect of digital step counter feedback on mobility after cesarean delivery: a randomized controlled trial. Obstetrics and Gynecology 2020;135(6):1345-52. [CENTRAL: CN-02131345] [EMBASE: 631910090] [PMID: ] - PubMed
    1. Herman HG, Kleiner I, Tairy D, Gonen N, Ben ZM, Kovo M, et al. 623: improving post-Cesarean mobility with personalized feedback using digital step counters - a randomized controlled trial. American Journal of Obstetrics and Gynecology 2020;222(1):S397-8. [CENTRAL: CN-02075395] [EMBASE: 2004455439]
Movahedi 2020 {published data only}
    1. Movahedi M, Motamedi M, Sajjadieh A, Bahrami P, Saeedi M. Pregnancy outcome in women with mechanical prosthetic heart valves at their first trimester of pregnancy treated with unfractionated heparin (UFH) or enoxaparin: a randomized clinical trial. Journal of Cardiovascular and Thoracic Research 2020;12(3):209-13. [CENTRAL: CN-02194966] [EMBASE: 632980316] [PMID: ] - PMC - PubMed
Nagornaya 2012 {published data only}
    1. Nagornaya V, Gonta R, Nickolay K, Pokhilchenko M. The risk of venous thromboembolism and its prevention in obstetrics. International Journal of Gynecology and Obstetrics 2012;119(Suppl 3):S796.
NCT02856295 {published data only}
    1. NCT02856295. anti10a levels in women treated with LMWH in the postpartum period. Https://clinicaltrials.gov/show/NCT02856295 (first received 2016 August 04). [CENTRAL: CN-01592274]
NCT04305756 {published data only}
    1. NCT04305756. Impact of prophylactic low-molecular weight heparin dosing on clotting parameters following cesarean delivery. Https://clinicaltrials.gov/show/NCT04305756 (first received 2020 March 12). [CENTRAL: CN-02089003]
NCT04635839 {published data only}
    1. NCT04635839. Heparin Prophylaxis Dosing for antepartum hospitalizations (HEPDOSE). Https://clinicaltrials.gov/show/NCT04635839 (first received 2020 Nov 19). [CENTRAL: CN-02205733]

References to ongoing studies

Dargaud 2018 {published data only}
    1. Dargaud Y, NCT03659708. Prospective multicentre randomized clinical trial on the management of pregnancies with high risk of venous thrombosis. https://clinicaltrials.gov/ct2/show/NCT03659708 (first received 6 September 2018).
Heller 2016b {published data only}
    1. Heller J. Compression stocking use in multiparous women during pregnancy & its effects on chronic venous insufficiency. Phlebology 2016;31(2 Suppl):42-3.
NCT00225108 {published data only}
    1. NCT00225108. The STOP CLOT pilot study: study of low molecular weight heparin in high risk postpartum women following cesarean section (ongoing trial). http://clinicaltrials.gov/show/NCT00225108 (first received 21 March 2006).
NCT00878826 {published data only}
    1. NCT00878826. Prophylactic enoxaparin dosing for prevention of venous thromboembolism in pregnancy. http://clinicaltrials.gov/ct2/show/record/NCT00878826 (first received 31 March 2013).
NCT01019655 {published data only}
    1. NCT01019655. Heparin for pregnant with thrombophilia. http://clinicaltrials.gov/show/NCT01019655 (first received 29 July 2012).
NCT01828697 {published data only}
    1. Bistervels I, Bleker S, Middeldorp S, Buchmuller A, Decousus H, Chauleur C, et al. Induced delivery and neuraxial anesthesia in pregnant women using thromboprophylaxis: data from the highlow study. Research and Practice in Thrombosis and Haemostasis 2017;1:41-2.
    1. Bistervels I, Buchmüller A, Bleker S, Chauleur C, Ni Ainle F, Donnelly J, et al. Neuraxial anesthesia in pregnant women using thrombosis prophylaxis: data from the Highlow study. Thrombosis Research 2017;Conference: 7th International Symposium on Women's Health Issues in Thrombosis and Haemostasis. Spain. 151(Suppl 1):S131-2.
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NCT04153760 {published data only}
    1. NCT04153760. Pilot PARTUM Trial: Postpartum Aspirin to reduce thromboembolism undue morbidity (PARTUM). https://clinicaltrials.gov/ct2/show/NCT04153760 (first received 19 August 2020).

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References to other published versions of this review

Bain 2014
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