Efficacy and safety of low-dose aspirin combined with low-molecular-weight heparin in treatment of preeclampsia: a meta-analysis and systematic review

Introduction: The role of low-dose aspirin combined with low -molecu-lar-weight heparin (LMWH) in the treatment of preeclampsia (PE) remains unclear. We aimed to assess the efficacy and safety of low-dose aspirin combined with LMWH in PE treatment, to provide evidence for clinical PE management.Material and methods: We searched PubMed and other databases for ran-domized controlled trials (RCTs) on the effects and safety of low-dose aspi-rin and LMWH in the treatment of PE up to January 31, 2021. Two research-ers strictly followed the inclusion and exclusion criteria to independently conduct the literature screening, data extraction and quality evaluation. We used RevMan 5.3 statistical software for synthesized analysis.Results: A total of 8 RCTs involving 861 patients were included. The syn-thesized outcome indicated that the differences in systolic blood pres-sure (MD = -10.61, 95% CI: -13.19 - -8.02), diastolic blood pressure (MD = -9.24, 95% CI: -14.49- -4.00), 24-hour urinary protein (MD = -2.24, 95% CI: -3.97- -0.50), prothrombin time (MD = 1.42, 95% CI: 0.53-2.32), activated partial thromboplastin time (MD = 2.91, 95% CI: 2.06-3.75), FIB (MD = -1.24, 95% CI: -1.32- -1.15), and adverse perinatal outcomes (MD = 0.41, 95% CI: 0.20-0.85) between the two groups were statistically significant (all p < 0.05), while the difference in the adverse reactions of pregnant women (MD = 0.44, 95% CI: 0.18-1.10) between the two groups was not statistically significant (p = 0.08). No publication bias was detected in all the synthesized outcomes (all p > 0.05).Conclusions: Low-dose aspirin combined with LMWH treatment of PE may be advantageous to improve blood pressure, 24-hour proteinuria and coagu-lation function, and it may reduce the adverse reactions in pregnant women without increasing adverse perinatal outcomes.

Automated summary

The synthesis analysis indicated that the combination of low-dose aspirin and LMWH in the treatment of PE can significantly improve blood pressure, 24-hour proteinuria, and coagulation function, and may reduce adverse reactions in pregnant women without increasing adverse perinatal outcomes. No publication bias was detected in all synthesized outcomes.