Meta-Analysis Of Low-Molecular-Weight Heparin For Prevention Of Ischemic Placental Disease

Objective:To evaluate the preventive effect of low-molecular-weight heparin (LMWH) on women at risk of developing ischemic placental disease (IPD), so as to provide relevant recommendations in clinical treatment.Method:By using electronic and manual retrieval, clinical randomized controlled trials (RCT) with respect to intervention treatment of placental ischemic diseases by LMWH as of December 2014 were collected; of indocuments were screened according to the inclusion and exclusion standards as set forward by two researchers on the basis of the methods for Cochrane systemative review, full text of chosen papers were accessed and reviewed, appropriate data were extracted, and the extracted data were subject to Meta analysis using RevMan5.2 software.Results:Six randomized controlled trials including a total of 854 patients were included in this study. The actual cases of 845 were divided into two subgroups, the LMWH group (482 cases) and the LMWH combined low dose aspirin (LDA) group (363 cases). The Jadad Scale was applied for literature quality assessment, and the results indicated that all documents were of high quality. Meta-analysis showed that:in the prevention of ischemic placental disease:(1) the LMWH group was significantly different from the control group in terms of the occurrence of preeclampsia(PE):odds ratio (OR)=0.32,95% confidence interval (CI) 0.12-0.84, P=0.02 and that of fetal growth restriction (FGR)(OR=0.28,95% CI 0.16-0.48, P< 0.00001), and showed no statistical difference in the prevention of placental abruption(PA) (OR=0.28,95% CI 0.06-1.37, P=0.12). (2) comparison of LMWH+LDA with LDA, there were statistical differences in the prevention of preeclampsia (OR=0.47,95% CI 0.25-0.89, P=0.02) and fetal growth restriction (OR=0.46,95%CI0.25-0.86, P=0.02), and no significant differences in the occurrence of placental abruption (OR=0.66,95% CI 0.11-3.99, P=0.65).Conclusion:LMWH is to a certain degree effective in the prophylaxis of IPD,comparison of LMWH+LDA with LDA group,the former is more effective,but this conclusion needs to be supported by multi-center, large sample, randomized double-blind clinical trials.