Efficacy of Low Molecular Weight Heparin in Preventing Perinatal Venous Thrombosis: A Meta-Analysis

Abstract

Background. There have been controversies about the preventive effect of low molecular weight heparin (LMWH) on venous thrombosis (VT) in the perinatal period. This study is aimed at exploring the effectiveness of LMWH in preventing perinatal VT through meta-analysis. Methods. Databases such as CNKI, China Biology Medicine disc (CBMdisc), Wanfang, PubMed, MEDLINE, Embase, and Central were searched. Inclusion criteria were as follows: (1) subjects: women at high risk of perinatal VT; (2) experimental group and control group; (3) intervention measures: the experimental group was given LMWH, while the control group was given placebo or standard heparin or physical therapy; (4) outcomes: perinatal VT events or bleeding events; and (5) randomized controlled trials (RCTs). Jadad scale was used to evaluate the literature quality. The Mantel-Haenszel method was used to calculate the odds ratio (OR) and 95% confidence interval (CI). The chi-square test was used to analyze the heterogeneity of the included literature. Subgroup analysis was used to explore the source of heterogeneity. Publication bias was evaluated via funnel plot and Egger test. Results. The incidence of perinatal VT in the LMWH group was lower than that in the control group ( $\text{OR}=0.16$ , 95% CI (0.08, 0.32), $P<0.00001$ ). There was no heterogeneity among literatures ( $P=0.77$ , $I^2=0\%$ ) and no publication bias. The incidence of postpartum VT in the LMWH group was lower than that in the control group ( $\text{OR}=0.14$ , 95% CI (0.07, 0.30), $P<0.00001$ ). There was no heterogeneity among literatures ( $P=0.69$ , $I^2=0\%$ ) and no publication bias. The incidence of perinatal bleeding in the LMWH group was higher than in the control group ( $\text{OR}=1.72$ , 95% CI (1.06, 2.77), $P=0.03$ ). There was no heterogeneity among literatures ( $P=0.25$ , $I^2=26\%$ ) and no publication bias. Conclusion. LMWH can reduce the incidence of perinatal VT in high-risk women but increase the risk of bleeding. The use of LMWH to prevent perinatal VT should be closely monitored.