Department of Gynecology and Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
Department of Gynecology and Obstetrics, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
Eur J Obstet Gynecol Reprod Biol. 2022 Jan;268:22-30. doi: 10.1016/j.ejogrb.2021.10.036. Epub 2021 Nov 10.
Unexplained recurrent miscarriage (uRM) has caused serious distress to women of childbearing age, and effective treatment is particularly important. The aim of this meta-analysis is to compare the efficacy of low molecular weight heparin (LMWH) and LMWH combined with aspirin for uRM.
Databases including PubMed, Web of Science, Embase, Scopus and the Cochrane Library databases were electronically searched to identify randomized controlled trials that reported the LMWH or LMWH combined with aspirin for women with uRM and negative antiphospholipid antibodies (aPL). The retrieval time is limited from inception to June 2021. Two reviewers independently screened literature, extracted data, and assessed risk bias of included studies. Meta-analysis was performed by using STATA 12.0 software.
A total of 7 studies involving 1849 patients were included. The meta-analysis results showed that compared with the control group, both LMWH and LMWH + aspirin interventions showed no substantial influence on miscarriage rate (LMWH: RR = 0.69, 95%CI: 0.34-1.39, P = 0.293, LMWH + aspirin: RR = 0.62, 95%CI: 0.30-1.27, P = 0.19) and the occurrence of pre-eclampsia (LMWH: RR = 1.1, 95%CI: 0.53-2.31, P = 0.792; LMWH + aspirin: RR = 1.49, 95%CI: 0.25-8.79, P = 0.662). LMWH therapy had no influence on the live births (RR = 0.99, 95%CI: 0.92-1.06, P = 0.72). Subgroup analysis showed that enoxaparin is not effective in women with uRM and negative aPL (miscarriage rate: RR = 0.82, 95%CI: 0.31-2.19, P = 0.695; pre-eclampsia: RR = 1.03, 95%CI: 0.46-2.33, P = 0.936).
LMWH and LMWH combined with aspirin therapy cannot improve the pregnancy outcome of women with uRM and negative aPL. However, the above conclusions are still required to be verified through more RCTs due to the limited quantity of included studies.
不明原因复发性流产（uRM）给育龄妇女带来了严重困扰，有效的治疗方法尤为重要。本荟萃分析旨在比较低分子肝素（LMWH）与 LMWH 联合阿司匹林治疗 uRM 的疗效。
电子检索 PubMed、Web of Science、Embase、Scopus 和 Cochrane 图书馆数据库，以确定报告 LMWH 或 LMWH 联合阿司匹林治疗 uRM 且抗磷脂抗体（aPL）阴性的随机对照试验。检索时间限定为 2021 年 6 月之前。由两名审阅者独立筛选文献、提取数据并评估纳入研究的偏倚风险。采用 STATA 12.0 软件进行荟萃分析。
共纳入 7 项研究，涉及 1849 例患者。荟萃分析结果显示，与对照组相比，LMWH 和 LMWH+阿司匹林干预均未对流产率（LMWH：RR=0.69，95%CI：0.34-1.39，P=0.293；LMWH+阿司匹林：RR=0.62，95%CI：0.30-1.27，P=0.19）和子痫前期的发生（LMWH：RR=1.1，95%CI：0.53-2.31，P=0.792；LMWH+阿司匹林：RR=1.49，95%CI：0.25-8.79，P=0.662）产生显著影响。LMWH 治疗对活产儿无影响（RR=0.99，95%CI：0.92-1.06，P=0.72）。亚组分析显示，依诺肝素对 uRM 且 aPL 阴性的妇女无效（流产率：RR=0.82，95%CI：0.31-2.19，P=0.695；子痫前期：RR=1.03，95%CI：0.46-2.33，P=0.936）。
LMWH 和 LMWH 联合阿司匹林治疗不能改善 uRM 且 aPL 阴性妇女的妊娠结局。然而，由于纳入研究数量有限，上述结论仍需更多 RCT 加以验证。
