Cochrane · systematic review · CD001689
Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period
Middleton, P, Shepherd, E, Gomersall, JC · Cochrane Database of Systematic Reviews · 2021 · Cochrane Library
Pregnancy and ChildbirthAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
30
current version
GRADE rated
23
No studies
7
Included studies
NR
No studies 7 · 23.3%Ungraded 0 · 0%Very low 23 · 76.7%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Antenatal (± postnatal) prophylaxis: heparin (LMWH or UFH) versus no treatment/placebo
Population: pregnant women at increased risk of VTE during pregnancy and the early postnatal period
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal death Antenatal (± postnatal) prophylaxis: heparin (LMWH or UFH) vs no treatment/placebo | no estimate extracted | NR | No studies |
Symptomatic thromboembolic events ( Antenatal (± postnatal) prophylaxis: heparin (LMWH or UFH) vs no treatment/placebo | RR 0.39 [0.08, 1.98] | 4 studies · 476 participants | Very low Downgraded: risk of bias |
Symptomatic PE ( Antenatal (± postnatal) prophylaxis: heparin (LMWH or UFH) vs no treatment/placebo | RR 0.33 [0.02, 7.14] | 3 studies · 187 participants | Very low Downgraded: risk of bias |
Symptomatic DVT ( Antenatal (± postnatal) prophylaxis: heparin (LMWH or UFH) vs no treatment/placebo | RR 0.33 [0.04, 3.1] | 4 studies · 227 participants | Very low Downgraded: risk of bias |
Adverse effects sufficient to stop treatment Antenatal (± postnatal) prophylaxis: heparin (LMWH or UFH) vs no treatment/placebo | RR 0.49 [0.05, 5.31] | 1 study · 139 participants | Very low Downgraded: risk of bias |
Antenatal (± postnatal) prophylaxis: LMWH versus UFH
Population: pregnant women at increased risk of VTE during pregnancy and the early postnatal period
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal death Antenatal (± postnatal) prophylaxis: LMWH vs UFH | no estimate extracted | NR | No studies |
Symptomatic thromboembolic events ( Antenatal (± postnatal) prophylaxis: LMWH vs UFH | RR 0.47 [0.09, 2.49] | 4 studies · 404 participants | Very low Downgraded: risk of bias |
Symptomatic PE ( Antenatal (± postnatal) prophylaxis: LMWH vs UFH | no estimate extracted | 3 studies · 287 participants | Very low Downgraded: risk of bias |
Symptomatic DVT ( Antenatal (± postnatal) prophylaxis: LMWH vs UFH | no estimate extracted | 3 studies · 287 participants | Very low Downgraded: risk of bias |
Adverse effects sufficient to stop treatment Antenatal (± postnatal) prophylaxis: LMWH vs UFH | RR 0.07 [0.01, 0.54] | 2 studies · 226 participants | Very low Downgraded: risk of bias |
Peripartum/postnatal prophylaxis: UFH versus no treatment
Population: women with varicose veins before birth, having a caesarean (elective or emergency) or vaginal birth
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal death Peripartum/postnatal prophylaxis: UFH vs no treatment | no estimate extracted | NR | No studies |
Symptomatic thromboembolic events ( Peripartum/postnatal prophylaxis: UFH vs no treatment | RR 0.16 [0.02, 1.36] | 1 study · 210 participants | Very low Downgraded: risk of bias |
Symptomatic PE ( Peripartum/postnatal prophylaxis: UFH vs no treatment | RR 0.16 [0.01, 3.34] | 1 study · 210 participants | Very low Downgraded: risk of bias |
Symptomatic DVT ( Peripartum/postnatal prophylaxis: UFH vs no treatment | RR 0.27 [0.03, 2.55] | 1 study · 210 participants | Very low Downgraded: risk of bias |
Adverse effects sufficient to stop treatment Peripartum/postnatal prophylaxis: UFH vs no treatment | no estimate extracted | NR | No studies |
Peripartum/postnatal prophylaxis (caesarean): heparin (LMWH or UFH) versus no treatment/placebo
Population: women giving birth by elective or emergency caesarean (elective only (1 trial), emergency or elective (4 trials))
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal death (timing of assessment unclear) Peripartum/postnatal prophylaxis (caesarean): heparin (LMWH or UFH) vs no treatment/placebo | no estimate extracted | 1 study · 300 participants | Very low Downgraded: risk of bias |
Symptomatic thromboembolic events (timing of assessment unclear, within 6 weeks postpartum) Peripartum/postnatal prophylaxis (caesarean): heparin (LMWH or UFH) vs no treatment/placebo | RR 1.3 [0.39, 4.27] | 4 studies · 840 participants | Very low Downgraded: risk of bias, imprecision |
Symptomatic PE (timing of assessment unclear, within 6 weeks postpartum) Peripartum/postnatal prophylaxis (caesarean): heparin (LMWH or UFH) vs no treatment/placebo | RR 1.1 [0.25, 4.87] | 4 studies · 840 participants | Very low Downgraded: risk of bias, imprecision |
Symptomatic DVT (timing of assessment unclear, within 6 weeks postpartum) Peripartum/postnatal prophylaxis (caesarean): heparin (LMWH or UFH) vs no treatment/placebo | no estimate extracted | 5 studies · 1140 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects sufficient to stop treatment Peripartum/postnatal prophylaxis (caesarean): heparin (LMWH or UFH) vs no treatment/placebo | no estimate extracted | 1 study · 140 participants | Very low Downgraded: risk of bias, imprecision |
Peripartum/postnatal prophylaxis (caesarean): LMWH versus UFH
Population: women giving birth by elective or emergency caesarean (elective or emergency (1 trial), elective cesarean only (1 trial), elective/emergency unclear (1 trial))
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal death Peripartum/postnatal prophylaxis (caesarean): LMWH vs UFH | no estimate extracted | NR | No studies |
Symptomatic thromboembolic events (timing of assessment unclear, within 6 weeks postpartum) Peripartum/postnatal prophylaxis (caesarean): LMWH vs UFH | RR 0.33 [0.01, 7.99] | 3 studies · 217 participants | Very low Downgraded: risk of bias |
Symptomatic PE (timing of assessment unclear, within 6 weeks postpartum) Peripartum/postnatal prophylaxis (caesarean): LMWH vs UFH | no estimate extracted | 3 studies · 217 participants | Very low Downgraded: risk of bias |
Symptomatic DVT (timing of assessment unclear, within 6 weeks postpartum) Peripartum/postnatal prophylaxis (caesarean): LMWH vs UFH | RR 0.33 [0.01, 7.99] | 3 studies · 217 participants | Very low Downgraded: risk of bias |
Adverse effects sufficient to stop treatment Peripartum/postnatal prophylaxis (caesarean): LMWH vs UFH | no estimate extracted | NR | No studies |
Postnatal prophylaxis: LMWH versus no treatment/placebo
Population: women at increased risk of VTE in the early postpartum period
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Maternal death Postnatal prophylaxis: LMWH vs no treatment/placebo | no estimate extracted | 1 study · 24 participants | Very low Downgraded: risk of bias |
Symptomatic thromboembolic events ( Postnatal prophylaxis: LMWH vs no treatment/placebo | no estimate extracted | 2 studies · 58 participants | Very low Downgraded: risk of bias, imprecision |
Symptomatic PE ( Postnatal prophylaxis: LMWH vs no treatment/placebo | no estimate extracted | 2 studies · 58 participants | Very low Downgraded: risk of bias, imprecision |
Symptomatic DVT ( Postnatal prophylaxis: LMWH vs no treatment/placebo | no estimate extracted | 2 studies · 58 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects sufficient to stop treatment Postnatal prophylaxis: LMWH vs no treatment/placebo | no estimate extracted | NR | No studies |