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Meta-Analysis
. 2024 Jun 19;14(1):14168.
doi: 10.1038/s41598-024-62949-5.

Low-molecular-weight heparin in the prevention of unexplained recurrent miscarriage: a systematic review and meta-analysis

Margherita Scarrone  1 , Noemi Salmeri  1   2 , Giovanni Buzzaccarini  1   2 , Valentina Canti  3 , Federica Pasi  2 , Enrico Papaleo  2 , Patrizia Rovere-Querini  1   3 , Massimo Candiani  1   2 , Alessandra Alteri  4 , Andrea Busnelli  5   6 , Valeria Stella Vanni  7   8
Affiliations
Meta-Analysis

Low-molecular-weight heparin in the prevention of unexplained recurrent miscarriage: a systematic review and meta-analysis

Margherita Scarrone et al. Sci Rep. .

Abstract

The etiology of recurrent pregnancy loss (RPL) is complex and multifactorial and in half of patients it remains unexplained (U-RPL). Recently, low-molecular-weight heparin (LMWH) has gained increasing relevance for its therapeutic potential. On this regard, the aim of this systematic review and meta-analysis is to analyze the efficacy of low molecular weight heparin (LMWH) from the beginning of pregnancy in terms of live birth rates (LBR) in U-RPL. Registered randomized controlled trials (RCTs) were included. We stratified findings based on relevant clinical factors including number of previous miscarriages, treatment type and control type. Intervention or exposure was defined as the administration of LMWH alone or in combination with low-dose aspirin (LDA). A total of 6 studies involving 1016 patients were included. The meta-analysis results showed that LMWH used in the treatment of U-RPL was not associated with an increase in LBR with a pooled OR of 1.01, a medium heterogeneity (26.42%) and no publication bias. Results of other sub-analyses according to country, treatment type, and control type showed no significant effect of LMWH on LBR in all subgroups, with a high heterogeneity. The results highlight a non-significant effect of LMWH in U-RPL on LBR based on moderate quality evidence.Registration number: PROSPERO: ( https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022326433 ).

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Conflict of interest statement

This article received no funding. E.P. reports grant and personal fees from MSD, grants from Ferring, from IBSA, grants and personal fees from Merck, grants from TEVA, grants from Gedeon Richter, not related to the present study. VSV reports consultancies with IBSA and Gedeon Richter, not related to the present study. All the other authors have no conflicts of interest to declare in this manuscript preparation.

Figures

Figure 1
Figure 1
PRISMA 2020 flow diagram for the identification of studies included in the systematic review and meta-analysis.
Figure 2
Figure 2
Assessment of risk of bias of randomized clinical trials included in this meta-analysis considering live-birth rate as outcome.
Figure 3
Figure 3
(a,b) Heparin and live births: random-effects meta-analysis of all included studies (n = 6). LB live births. (a) Forest plot: the estimate of the overall effect size is depicted by a green diamond centered at the estimate of the overall effect size. (b) Funnel plot for publication bias: Egger’s test: p = 0.0146; Begg’s test: p = 0.2597.
See this image and copyright information in PMC

References

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