ArticleBMC pregnancy and childbirth2025
Network meta-analysis: comparative efficacy of diverse aspirin dosages and heparin in mitigating placenta-mediated pregnancy complications.
Article in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThis study aimed to assess the comparative efficacy of different low-dose aspirin (ASA) dosages, either alone or in combination with heparin, in preventing placenta-mediated pregnancy complications (PMPC) among high-risk pregnant women using a network meta-analysis (NMA).
methodsPubMed, Embase, Cochrane Library, and Web of Science were systematically searched for randomized controlled trials (RCTs) up to August 15, 2025. Studies evaluating ASA (< 100 mg/day, ≥ 100 mg/day), unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), and their combinations in high-risk populations were included. Data from 63 RCTs (20,325 participants) were analyzed using Bayesian random-effects NMAs and trial sequential analysis (TSA).
resultsAll anticoagulant regimens significantly reduced preeclampsia (PE) risk by 24–95% compared to placebo/no treatment. The combination of < 100 mg/day ASA + LMWH notably decreased severe PE (odds ratio [OR] = 0.05, 95% confidence interval [CI] = 0.00–0.59) and miscarriage and stillbirth or perinatal death (OR = 0.50, 95% CI = 0.32–0.77). TSA confirmed that ≥ 100 mg/day ASA + LMWH significantly reduced PMPC risk. While LMWH alone showed efficacy in reducing placental abruption, combined regimens outperformed monotherapies in overall PMPC prevention. No significant differences in bleeding risk or neonatal outcomes (e.g., preterm delivery) were observed across regimens.
conclusionsAnticoagulant therapies, particularly combinations of ASA and LMWH, effectively mitigate PMPC. The < 100 mg/day ASA + LMWH regimen demonstrates optimal efficacy in reducing severe PE and fetal loss, while ≥ 100 mg/day ASA + LMWH is strongly supported by TSA. These findings inform clinical decisions for PMPC prophylaxis.
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