Antithrombotic therapy for women considered at risk of placental dysfunction

Heparin therapy appears to be effective for decreasing the risk of perinatal mortality, preterm birth before 34 and 37 weeks' gestation, and infant birthweight below the 10th centile for gestational age when compared with no treatment in women considered at risk of placental dysfunction. However, important information about serious adverse infant and long-term childhood outcomes is unavailable.

A Cochrane review included 10 studies with a total of 1039 subjects. 9 studies compared heparin (alone or in combination with dipyridamole or low-dose aspirin) with no treatment; and one compared trapidil (triazolopyrimidine). Heparin was associated with a reduction in the risk of perinatal mortality (RR 0.40; 95% confidence intervals (CI) 0.20 to 0.78; 6 trials, n=653), preterm birth before 34 (RR 0.46; 95% CI 0.29 to 0.73; 3 trials, n=494) and 37 (RR 0.72; 95% CI 0.58 to 0.90; 5 trials, n=621) weeks' gestation, and infant birthweight less than the 10th centile for gestational age (RR 0.41; 95% CI 0.27 to 0.61; 7 trials, n=710). There is a lack of reliable information of clinically relevant, serious adverse infant health outcomes.

Comment: The quality of evidence is downgraded by study quality (unclear blinding).

Ədəbiyyat

1. Dodd JM, McLeod A, Windrim RC, Kingdom J. Antithrombotic therapy for improving maternal or infant health outcomes in women considered at risk of placental dysfunction. Cochrane Database Syst Rev 2010 Jun 16;(6):CD006780 [Review content assessed as up-to-date: 24 October 2012].