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. 2021 Mar 29;2021(3):CD001689. doi: 10.1002/14651858.CD001689.pub4

Comparison 1. Antenatal (± postnatal) prophylaxis: Heparin (LMWH or UFH) versus no treatment/placebo.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1.1 Symptomatic thromboembolic events 4 476 Risk Ratio (M‐H, Fixed, 95% CI) 0.39 [0.08, 1.98]
1.1.1 LMWH 4 476 Risk Ratio (M‐H, Fixed, 95% CI) 0.39 [0.08, 1.98]
1.2 Symptomatic pulmonary embolism 3 187 Risk Ratio (M‐H, Fixed, 95% CI) 0.33 [0.02, 7.14]
1.2.1 LMWH 3 187 Risk Ratio (M‐H, Fixed, 95% CI) 0.33 [0.02, 7.14]
1.3 Symptomatic deep vein thrombosis 4 227 Risk Ratio (M‐H, Fixed, 95% CI) 0.33 [0.04, 3.10]
1.3.1 LMWH 3 187 Risk Ratio (M‐H, Fixed, 95% CI) 0.33 [0.01, 7.93]
1.3.2 UFH 1 40 Risk Ratio (M‐H, Fixed, 95% CI) 0.33 [0.01, 7.72]
1.4 Blood transfusion 1 16 Risk Ratio (M‐H, Fixed, 95% CI) Not estimable
1.4.1 LMWH 1 16 Risk Ratio (M‐H, Fixed, 95% CI) Not estimable
1.5 Bleeding episodes 4   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.5.1 LMWH: placental abruption 3 463 Risk Ratio (M‐H, Fixed, 95% CI) 1.00 [0.31, 3.20]
1.5.2 LMWH: peripartum haemorrhage 1 289 Risk Ratio (M‐H, Fixed, 95% CI) 0.65 [0.24, 1.79]
1.5.3 LMWH non‐major/minor bleeding 1 284 Risk Ratio (M‐H, Fixed, 95% CI) 2.12 [1.15, 3.93]
1.5.4 LMWH: major bleeding 1 284 Risk Ratio (M‐H, Fixed, 95% CI) 1.48 [0.25, 8.72]
1.5.5 UFH: antenatal vaginal bleeding 1 40 Risk Ratio (M‐H, Fixed, 95% CI) 1.00 [0.16, 6.42]
1.5.6 UFH: postpartum haemorrhage 1 40 Risk Ratio (M‐H, Fixed, 95% CI) 3.00 [0.13, 69.52]
1.6 Serious wound complications 1 16 Risk Ratio (M‐H, Fixed, 95% CI) Not estimable
1.6.1 LMWH 1 16 Risk Ratio (M‐H, Fixed, 95% CI) Not estimable
1.7 Adverse effects sufficient to stop treatment 1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.7.1 LMWH 1 139 Risk Ratio (M‐H, Fixed, 95% CI) 0.49 [0.05, 5.31]
1.8 Adverse effects not sufficient to stop treatment 4   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.8.1 LMWH: skin/allergic reactions 4 476 Risk Ratio (M‐H, Fixed, 95% CI) 5.11 [2.00, 13.08]
1.8.2 LMWH: raised liver enzymes 1 289 Risk Ratio (M‐H, Fixed, 95% CI) 22.53 [1.34, 378.78]
1.8.3 LMWH: haematoma 2 171 Risk Ratio (M‐H, Fixed, 95% CI) 3.98 [0.46, 34.23]
1.8.4 Superficial thrombophlebitis 1 139 Risk Ratio (M‐H, Fixed, 95% CI) 0.33 [0.01, 7.93]
1.8.5 LMWH: other 1 289 Risk Ratio (M‐H, Fixed, 95% CI) 0.98 [0.06, 15.51]
1.9 Symptomatic osteoporosis 4 479 Risk Ratio (M‐H, Fixed, 95% CI) 3.00 [0.13, 69.52]
1.9.1 LMWH 3 439 Risk Ratio (M‐H, Fixed, 95% CI) Not estimable
1.9.2 UFH 1 40 Risk Ratio (M‐H, Fixed, 95% CI) 3.00 [0.13, 69.52]
1.10 Fetal loss 4   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.10.1 LMWH or UFH: gestation unclear 2 329 Risk Ratio (M‐H, Fixed, 95% CI) 1.16 [0.54, 2.51]
1.10.2 LMWH: < 20 weeks 2 171 Risk Ratio (M‐H, Fixed, 95% CI) 2.18 [0.50, 9.41]
1.10.3 LMWH: ≥ 20 weeks 2 166 Risk Ratio (M‐H, Fixed, 95% CI) 0.33 [0.04, 3.12]
1.11 Thrombocytopenia 5 511 Risk Ratio (M‐H, Fixed, 95% CI) 3.00 [0.14, 64.26]
1.11.1 LMWH 4 471 Risk Ratio (M‐H, Fixed, 95% CI) 3.00 [0.14, 64.26]
1.11.2 UFH 1 40 Risk Ratio (M‐H, Fixed, 95% CI) Not estimable
1.12 Fetal anomalies 1   Risk Ratio (M‐H, Fixed, 95% CI) Subtotals only
1.12.1 LMWH 1 289 Risk Ratio (M‐H, Fixed, 95% CI) 2.94 [0.60, 14.32]