Meta-analysis for Efficacy of Two Anticoagulation Treatments in Patients After Mechanical Heart Valve Replacement at Pregnancy / 中国循环杂志

ABSTRACT

Objective: To evaluate the efficacy and safety for the application of low-dose vitamin K antagonist (VKA) during whole pregnancy and low-molecular-weight heparin/heparin at early pregnancy in patients after mechanical heart valve replacement. Methods: We searched the Cochrane library (2016 Issue 2), PubMed, EMbase, CBM, Tsinghua Tongfang (CNKI), Wanfang and VIP databases to collect the literatures for the application of low-dose VKA during whole pregnancy and low-molecular-weight heparin/heparin at early pregnancy up to 2016-06. The literatures were independently screened by 2 reviewers and Meta-analysis was performed using RevMan 5.3 software. Results: 12 studies were finally enrolled. Meta-analysis presented that compared with the application of low-molecular-weight heparin/heparin at early pregnancy, low-dose VKA during whole pregnancy showed decreased valvular thrombosis rate (OR=0.26, 95% CI 0.13-0.54, P<0.001), lower spontaneous abortion rate (OR=1.99, 95% CI 1.21-3.26, P=0.006) and increased fetal abnormality rate (OR=3.39, 95% CI 1.11-10.37, P=0.03); while the maternal mortality (OR=0.79, 95% CI 0.24-2.58, P=0.70), peri-natal bleeding rate (OR=0.56, 95% CI 0.27-1.18, P=0.13) and the incidence of stillbirth (OR=1.80, 95% CI 0.94-3.44, P=0.07) were similar between two conditions. Conclusion: Current evidence indicated that the application of low-doseVKA during whole pregnancy decreased the rates of valvular thrombosis and spontaneous abortion in patients after mechanical heart valve replacement, while increased the rate of fetal abnormality. Further investigation is needed to confirm the above conclusion.