A Meta-analysis Of The Clinical Efficacy And Adverse Reactions Of Low-dose Aspirin Combined With Low-molecular-weight Heparin In The Treatment Of PTS Recurrent Miscarriage

Objective:The purpose of this study was to compare the clinical efficacy and adverse reactions of low dose aspirin(LDA)combined with low molecular weight heparin(LMWH)and LDA alone in the treatment of recurrent miscarriage caused by prothrombotic state(PTS),to provide options for the medication of clinical PTS patients with recurrent miscarriage.Methods:The computer was used to search CNKI,Wanfang,Weipu,CBM,PubMed,Cochrane library,medical Medline databases ect....The search time was limited from January 2011 to december 2021,and the language was set in Chinese and English.According to the inclusion and exclusion criteria,we selected appropriate literature,evaluated quality and extracted data,and finally used Rev Man5.4 software to perform meta analysis and get the results.Results:A total of 15 Chinese literatures were included in this study,with a total sample size of 1324 cases,including 663 cases in the experimental group and661 cases in the control group.Meta-analysis results showed that LDA combin ed with LMWH increased the levels of estradiol,progesterone and human chor ionic gonadotropin in patients with PTS recurrent miscarriage[SMD=2.35,95%CI(0.64,4.07),P=0.007][SMD=2.62,95%CI(-0.36,5.61),P=0.09][SMD=9.84,95%CI(5.71,13.96),P<0.00001];reduced D-dimer,plasminogen activator inhibitor,fibrinogen[S MD=-1.25,95%CI(-1.87,-0.64),P<0.0001][SMD=-0.60,95%CI(-0.95,-0.26),P=0.0006][WMD=-0.61,95%CI(-1.06,-0.16),P=0.008],prolonged thrombin time and increa sed tissue-type plasminogen activator[SMD=1.22,95%CI(0.83,1.61),P<0.00001][S MD=2.25,95%CI(1.36,3.14),P<0.00001];improved the full-term birth rate[RR=1.47,95%CI(1.28,1.68),P<0.00001],and reduced the abortion rate[RR=0.41,95%CI(0.32,0.51),P<0.00001];preterm birth rate[RR=1.04,95%CI(0.86,1.27),P=0.67];feta l intrauterine growth restriction[RR=0.38,95%CI(0.14,1.05),P=0.06],oligohydramni os[RR=0.66,95%CI(0.19,2.28),P=0.51],hypertension during pregnancy[RR=0.56,95%CI(0.17,1.89),P=0.35],intrauterine death[RR=0.33,95%CI(0.05,2.05),P=0.23]and other pregnancy complications;gastrointestinal reactions[RR=0.81,95%CI(0.39,1.69),P=0.57],thrombocytopenia[RR=1.10,95%CI(0.48,2.51),P=0.82],bleeding[RR=0.62,95%CI(0.24,1.62),P=0.33]and other unadvisable reactions were not statistically d iverse.Conclusion:Low-dose aspirin combined with low-molecular-weight heparin could improve the pregnancy outcome of patients with PTS recurrent miscarriage and the patients’ hypercoagulable state,which was better than the control group with LDA alone in efficacy.The safety of clinical application was high,but clinical trials of more samples are needed to further verify it.