Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2021 Jun 25;100(25):e26264.
doi: 10.1097/MD.0000000000026264.

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

Ting Shi  1 , Zhong-Deng Gu  2 , Qi-Zhi Diao  3
Affiliations
Meta-Analysis

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

Ting Shi et al. Medicine (Baltimore). .

Abstract

Background: 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.

Methods: 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.

Results: 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 < .001). The subgroup analysis of the live birth rate was carried out based on the course of treatment, and the results were consistent with the overall results. Begg funnel plot test revealed no publication bias. Sensitivity analysis showed that deleting any study did not affect the results.

Conclusion: Aspirin combined with LMWH for APS may improve live birth rate, and detection of d-dimer levels in APS pregnant women may predict pregnancy complications and guide the use of anticoagulants.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
11 Summary of risk assessment of the included literature.
Figure 2
Figure 2
Literature screening flow chart.
Figure 3
Figure 3
Forest map assessing the difference in live birth rates between aspirin combined with low molecular weight heparin and aspirin antiphospholipid antibody syndrome alone.
Figure 4
Figure 4
Subgroup analysis of the difference in live birth rate between long and short course aspirin combined with low molecular weight heparin in antiphospholipid antibody syndrome pregnant women.
Figure 5
Figure 5
Forest map of the difference in live birth rates below and above baseline for d-dimer.
Figure 6
Figure 6
The Begg funnel plot was used to evaluate potential publication bias in meta-analyses.
Figure 7
Figure 7
Sensitivity analysis of the meta-analysis.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Rodrigues VO, Soligo AGES, Pannain GD. Antiphospholipid antibody syndrome and infertility. Rev Bras Ginecol Obstet 2019;41:621–7. - PubMed
    1. Li XY, Zhao JX, Liu XY. Diagnosis and treatment of antiphospholipid antibody-related recurrent spontaneous abortion and analysis of therapeutic drugs and pregnancy outcome in 75 patients with antiphospholipid syndrome. Beijing Da Xue Bao Yi Xue Ban 2018;50:956–61. - PubMed
    1. Gadó K, Domján G. Antiphospholipid syndrome and pregnancy. Orv Hetil 2012;153:1207–18. - PubMed
    1. Rahman A. Management of antiphospholipid syndrome. Clin Rheumatol 2020;39:2111–4. - PubMed
    1. Arnaud L, Mathian A, Ruffatti A, et al. . Efficacy of aspirin for the primary prevention of thrombosis in patients with antiphospholipid antibodies: an international and collaborative meta-analysis. Autoimmun Rev 2014;13:281–91. - PubMed

Publication types

MeSH terms