From the Department of Pathophysiology, Medical School, University of Athens, Greece.
Obstet Gynecol. 2010 Jun;115(6):1256-1262. doi: 10.1097/AOG.0b013e3181deba40.
To estimate the effect of combined heparin and aspirin compared with aspirin monotherapy in pregnant women with antiphospholipid syndrome and recurrent pregnancy loss.
We searched the PubMed database up to December 2009 for English-language studies using the key words "aspirin AND (heparin OR low molecular weight heparin), (antiphospholipid OR anticardiolipin OR aPL) AND pregnancy."
Two hundred ninety- two studies were initially screened. Randomized controlled trials comparing the effect of heparin (unfractionated heparin or low molecular weight heparin) plus aspirin compared with aspirin alone on the live-birth rate in women with a history of at least two miscarriages and antiphospholipid antibodies were eligible.
TABULATION, INTEGRATION, AND RESULTS: The pooled effect of unfractionated heparin and low molecular weight heparin was evaluable in three and two randomized controlled studies, respectively, with regard to live births, which was the major outcome. Overall, treatment effects were in favor of heparin against first-trimester losses (odd ratio [OR] 0.39, 95% confidence interval [CI] 0.24-0.65, number needed to treat 6). More specifically, unfractionated heparin displayed a significant effect (OR 0.26, 95% CI 0.14-0.48, number needed to treat 4), while the pooled effect of low molecular weight heparin was insignificant (OR 0.70, 95% CI 0.34-1.45). Combination therapy of either unfractionated heparin or low molecular weight heparin with aspirin failed to display any significant effect in the prevention of late-pregnancy losses. No significant differences were observed between treatment and control groups for any other outcomes.
The combination of unfractionated heparin and aspirin confers a significant benefit in live births. However, the efficacy of low molecular weight heparin plus aspirin remains unproven, highlighting the urgent need for large controlled trials.
评估与阿司匹林单药治疗相比，肝素联合阿司匹林治疗抗磷脂综合征合并复发性流产孕妇的效果。
我们检索了 PubMed 数据库，截至 2009 年 12 月，使用关键词“阿司匹林和（肝素或低分子量肝素），（抗磷脂或抗心磷脂或 aPL）和妊娠”搜索英文文献。
最初筛选了 292 项研究。符合条件的研究为比较肝素（普通肝素或低分子量肝素）联合阿司匹林与阿司匹林单药治疗对至少有 2 次流产史和抗磷脂抗体的女性活产率影响的随机对照试验。
列表、整合和结果：普通肝素和低分子量肝素的汇总效果可分别在三项和两项随机对照研究中评估，活产是主要结局。总体而言，肝素治疗效果有利于降低早期流产率（比值比 [OR] 0.39，95%置信区间 [CI] 0.24-0.65，需要治疗的人数 6）。更具体地说，普通肝素显示出显著的效果（OR 0.26，95%CI 0.14-0.48，需要治疗的人数 4），而低分子量肝素的汇总效果不显著（OR 0.70，95%CI 0.34-1.45）。无论是普通肝素还是低分子量肝素联合阿司匹林治疗，都不能显著预防晚期流产。在任何其他结局方面，治疗组与对照组之间未观察到显著差异。
普通肝素联合阿司匹林治疗可显著提高活产率。然而，低分子量肝素联合阿司匹林的疗效尚未得到证实，这突出表明迫切需要进行大型对照试验。
