Heparin to prevent recurrent placenta-mediated pregnancy complications in women with antiphospholipid syndrome: a systematic review.

BACKGROUND

For women with antiphospholipid syndrome (APS) and placenta-mediated complications, the efficacy of heparin during subsequent pregnancies is uncertain.

OBJECTIVES

This study systematically reviewed high-quality evidence on efficacy of low-molecular-weight heparin (LMWH) to prevent recurrent placenta-mediated pregnancy complications in women with APS.

METHODS

We searched Embase, MEDLINE, and CENTRAL to identify randomized controlled trials (RCTs) that assessed use of LMWH compared with any control in pregnant women with APS and previous placenta-mediated pregnancy complications (intrauterine growth restriction; birth of a small for gestational infant; preeclampsia; hemolysis, elevated liver enzymes, and low platelets syndrome; late fetal loss; and placental abruption). The primary outcome was recurrence of placenta-mediated pregnancy complications.

RESULTS

We identified 4007 records and included 2 RCTs. The TIPPS trial randomized eligible women to dalteparin or no dalteparin; 21 women with APS were included in this systematic review. The FRUIT trial randomized 32 women with APS to dalteparin and aspirin or aspirin only. The primary outcome of this systematic review occurred in 4 of 16 women in the intervention group of the FRUIT trial and in 3 to 6 of 16 women in the control group (risk difference, 6.25%; 95% CI, -22.3% to 34.8%; ranging to -12.5%; 95% CI, -44.3% to 19.3%, due to absent reporting on coinciding complications). The trials did not report on the outcome and population as defined in the current review in a manner that allowed pooling the primary outcome.

CONCLUSION

There is no high-quality evidence from RCTs that demonstrates a beneficial effect of LMWH in women with APS and placenta-mediated pregnancy complications without a history of recurrent miscarriage.