Heparin for preventing adverse obstetrical outcomes in pregnant women with antiphospholipid syndrome, a systematic review and meta-analysis

Guerby, Paul; Fillion, Alexandre; O’Connor, Sarah; Bujold, Emmanuel

doi:10.1016/j.jogoh.2020.101974

Cited by 16 publications

(4 citation statements)

References 32 publications

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“…Only one study by Sirico et al [ 28 ] analysed thromboprophylaxis with LMWH in women during the third trimester of pregnancy. Some studies reported increased risk in minor bleeding[ 18 , 24 , 25 , 31 ]. Majority of the meta-analyses found no significant difference in bleeding events rate in LMWH group compared with LDA or placebo.…”

Section: Discussionmentioning

confidence: 99%

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Low-molecular-weight heparin and preeclampsia — does the sword cut both ways? Three case reports and review of literature

Shan,

Li,

Tan

et al. 2024

World J Clin Cases

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BACKGROUND Low-molecular-weight heparins (LMWH) are the most commonly used anticoagulants during pregnancy. It is considered to be the drug of choice due to its safety in not crossing placenta. Considering the beneficial effect in the improvement of microcirculation, prophylactic application of LMWH in patients with preeclampsia became a trend. However, the bleeding risk related with LMWH in preeclampsia patients has seldomly been evaluated. This current study aimed to identify the potential risks regarding LMWH application in patients with preeclampsia. CASE SUMMARY Herein we present a case series of three pregnant women diagnosed with preeclampsia on LMWH therapy during pregnancy. All the cases experienced catastrophic hemorrhagic events. After reviewing the twenty-one meta-analyses, the bleeding risk related with LMWH seems ignorable. Only one study analyzed the bleeding risk of LMWH and found a significantly higher risk of developing PPH in women receiving LMWH. Other studies reported minor bleeding risks, none of these were serious enough to stop LMWH treatment. Possibilities of bleeding either from uterus or from intrabdominal organs in preeclampsia patients on LMWH therapy should not be ignored. Intensive management of blood pressure even after delivery and homeostasis suture in surgery are crucial. CONCLUSION Consideration should be given to the balance between benefits and risks of LMWH in patients with preeclampsia.

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Section: Discussionmentioning

confidence: 99%

“…For minor bleeding events, one study reported increased risk in LMWH group from nine trials. The risk for bruises and epistaxis was 2 times higher in patients in heparin group[ 18 ]. Bloody vaginal discharge, minor vaginal bleeding and subcutaneous hemorrhage from injection point were also reported.…”

Section: Discussionmentioning

confidence: 99%

Low-molecular-weight heparin and preeclampsia — does the sword cut both ways? Three case reports and review of literature

Shan,

Li,

Tan

et al. 2024

World J Clin Cases

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“…Although there is no evidence for the beneficial effects of heparin in reducing adverse neonatal outcomes ( 179 ). This helps to avoid adverse pregnancy outcomes ( 180 , 181 ). Recent studies have shown that LMWH can bind to HMGB1, resulting in a reduced affinity of HMGB1 for RAGE.…”

Section: Hmgb1-targeted Therapeutic Agentsmentioning

confidence: 99%

HMGB1: a double-edged sword and therapeutic target in the female reproductive system

Ren,

Zhu,

Han

et al. 2023

Front. Immunol.

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HMGB1 that belongs to the High Mobility Group-box superfamily, is a nonhistone chromatin associated transcription factor. It is present in the nucleus of eukaryotes and can be actively secreted or passively released by kinds of cells. HMGB1 is important for maintaining DNA structure by binding to DNA and histones, protecting it from damage. It also regulates the interaction between histones and DNA, affecting chromatin packaging, and can influence gene expression by promoting nucleosome sliding. And as a DAMP, HMGB1 binding to RAGE and TLRs activates NF-κB, which triggers the expression of downstream genes like IL-18, IL-1β, and TNF-α. HMGB1 is known to be involved in numerous physiological and pathological processes. Recent studies have demonstrated the significance of HMGB1 as DAMPs in the female reproductive system. These findings have shed light on the potential role of HMGB1 in the pathogenesis of diseases in female reproductive system and the possibilities of HMGB1-targeted therapies for treating them. Such therapies can help reduce inflammation and metabolic dysfunction and alleviate the symptoms of reproductive system diseases. Overall, the identification of HMGB1 as a key player in disease of the female reproductive system represents a significant breakthrough in our understanding of these conditions and presents exciting opportunities for the development of novel therapies.

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“…The efficacy of aspirin and/or heparin in improving pregnancy outcomes among APLs-positive patients has been confirmed by multiple studies. [ 76 , 77 ] A systematic review, which included 11 studies (9 RCTs and 2 quasi-RCTs) with a total of 1672 female patients with persistent positive APLs, demonstrated that the combination of aspirin and heparin (either unfractionated heparin or LMWH) significantly increased the live birth rate (risk ratio (RR) = 1.27, 95% CI:1.09–1.49) compared to aspirin alone, without serious adverse events or congenital malformations. [ 78 ] Based on several international guidelines, treatment stratification should be conducted considering obstetric clinical manifestations, prior history of thrombosis, and the specific types of positive APLs.…”

Section: Management Of Sle Patients With Positive Apls During Pregnancymentioning

confidence: 99%

2022 Chinese guideline for the management of pregnancy and reproduction in systemic lupus erythematosus

Tian,

Zhao,

Song

et al. 2023

Rheumatology and Immunology Research

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Systemic lupus erythematosus (SLE), a prevalent autoimmune disease predominantly affecting women of childbearing age, presents ongoing challenges despite notable advances in diagnosis and treatment. Although survival rates for SLE patients have significantly improved, pregnancy continues to pose a considerable obstacle. Addressing this critical need for enhanced reproductive and prenatal care, there is a pressing imperative to establish standardized protocols for peri-gestational monitoring and treatment in SLE patients. This guideline is jointly sponsored by the National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), the Chinese Systemic Lupus Erythematosus Treatment and Research Group (CSTAR), and the Chinese Research Committee of Pregnancy and Reproduction in Autoimmune Rheumatic Diseases (CHOPARD). Thirteen pertinent clinical questions have been generated through several rounds of rigorous clinical and methodological expert discussions and selections for a comprehensive understanding of key aspects in this domain. Guided by thorough examination of research evidence and expert perspectives, the formulated recommendations aim to optimize pregnancy success rates, reduce maternal and infant mortality rates, and ultimately enhance the overall well-being of SLE patients.

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Heparin for preventing adverse obstetrical outcomes in pregnant women with antiphospholipid syndrome, a systematic review and meta-analysis

Cited by 16 publications

References 32 publications

Low-molecular-weight heparin and preeclampsia — does the sword cut both ways? Three case reports and review of literature

Low-molecular-weight heparin and preeclampsia — does the sword cut both ways? Three case reports and review of literature

HMGB1: a double-edged sword and therapeutic target in the female reproductive system

2022 Chinese guideline for the management of pregnancy and reproduction in systemic lupus erythematosus

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