Aspirin and heparin for the prevention of pre-eclampsia: protocol for a systematic review and network meta-analysis

Abstract

IntroductionPre-eclampsia is an important cause of death and complication for pregnant women and perinatal infant. Low-dose aspirin has been most commonly used to prevent pre-eclampsia in high-risk pregnant women. Recently, heparins have also been used alone or in combination with aspirin to prevent pre-eclampsia. However, the optimal doses and combination therapy of aspirin and heparins are not well established. Therefore, we aim to compare aspirin, heparins and their combination to prevent pre-eclampsia in a network meta-analysis.Methods and analysisWe will search the following electronic databases from the date of database establishment to 8 January 2019: PubMed, Embase, Cochrane Library, Web of Science and ProQuest. We will also search additional studies manually. There will be no restriction on the language of publications. Only randomised clinical trials will be eligible in our network meta-analysis. We will include pregnant women who have been recommended for aspirin according to the standard of the American Congress of Obstetricians and Gynecologists, or were designated as high risk in some recent studies. We will include studies comparing the effects of any single or combination of aspirin and heparins with placebo or observation or another intervention in pregnancy. We will include studies that reported one of the following outcomes: pre-eclampsia, severe pre-eclampsia, preterm delivery, perinatal death and full-term pre-eclampsia with delivery at ≥37 weeks. Traditional pairwise meta-analysis will be performed initially, and then network meta-analysis will be performed using frequency analysis method. Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the findings.Ethics and disseminationThis network meta-analysis does not require ethical certification. An overview and information on the prevention of pre-eclampsia in high-risk pregnant women will be provided by this network meta-analysis.PROSPERO registration numberCRD42018084248.

Monitoring of Pregnancy-Induced Hypertension Syndrome Combined with Ultrasound Monitoring in Early Pregnancy to Prevent Chronic Hypertension with Preeclampsia

“…The main mechanism of action of aspirin is that it reduces endothelial cell injury and inhibits platelet aggregation and thrombosis, thereby having antihypertensive and anticoagulant effects [35,36]. Aspirin at a low dose does not increase the incidence of maternal thrombocytopenia, maternal postpartum hemorrhage, or prenatal and postpartum hemorrhage, nor does it increase the bleeding tendency and neonatal disease rate of the newborns; therefore, oral administration of low-dose aspirin during pregnancy is relatively safe for mothers and infants [37][38][39].…”

Analysis of perinatal coagulation function in preeclampsia

“…[ 12 ] LMWH can combine with anticoagulant live enzymes AT. The inhibition of AT on FXa and thrombin is enhanced, [ 9 ] while the influence on platelet counts is small. Several clinical trials [ 25 – 26 ] have demonstrated that LMWH is beneficial for improving pregnancy outcomes in pregnant women with severe PE, fetal growth restriction, and thrombotic tendency.…”

“…It is gradually recognized clinically by blocking the malignant process of coagulation reaction. [ 9 ]…”

“…Administration of anticoagulants, such as low molecular weight heparin (LMWH) and AT, is an effective treatment for patients with severe PE complicated by DIC. It is gradually recognized clinically by blocking the malignant process of coagulation reaction [9] …”

Consolidation treatments after chemoradiotherapy in patients with locally advanced inoperable non-small cell lung cancer: a systematic review and network meta-analysis protocol

“…Otherwise, we will use the data available to us, but the potential impact of them will be addressed in the assessment of risk of bias. If we cannot get the reply from authors, the data will be verified from other trials in the network or from other published meta-analyses 47 48…”