scholarly journals Aspirin and heparin for the prevention of pre-eclampsia: protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e026920
Author(s):  
Jinzhu Huang ◽  
Xiaohong Chen ◽  
Haiyan Xing ◽  
Lin Chen ◽  
Zhaolu Xie ◽  
...  
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Perinatal Death ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Analysis Method ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Registration Number

IntroductionPre-eclampsia is an important cause of death and complication for pregnant women and perinatal infant. Low-dose aspirin has been most commonly used to prevent pre-eclampsia in high-risk pregnant women. Recently, heparins have also been used alone or in combination with aspirin to prevent pre-eclampsia. However, the optimal doses and combination therapy of aspirin and heparins are not well established. Therefore, we aim to compare aspirin, heparins and their combination to prevent pre-eclampsia in a network meta-analysis.Methods and analysisWe will search the following electronic databases from the date of database establishment to 8 January 2019: PubMed, Embase, Cochrane Library, Web of Science and ProQuest. We will also search additional studies manually. There will be no restriction on the language of publications. Only randomised clinical trials will be eligible in our network meta-analysis. We will include pregnant women who have been recommended for aspirin according to the standard of the American Congress of Obstetricians and Gynecologists, or were designated as high risk in some recent studies. We will include studies comparing the effects of any single or combination of aspirin and heparins with placebo or observation or another intervention in pregnancy. We will include studies that reported one of the following outcomes: pre-eclampsia, severe pre-eclampsia, preterm delivery, perinatal death and full-term pre-eclampsia with delivery at ≥37 weeks. Traditional pairwise meta-analysis will be performed initially, and then network meta-analysis will be performed using frequency analysis method. Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the findings.Ethics and disseminationThis network meta-analysis does not require ethical certification. An overview and information on the prevention of pre-eclampsia in high-risk pregnant women will be provided by this network meta-analysis.PROSPERO registration numberCRD42018084248.

scholarly journals The Risk of Gastrointestinal Hemorrhage in Low-Dose Aspirin Users with Diabetes Mellitus: Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yashuo Wang ◽  
Wei Wang ◽  
Bin Wang ◽  
Yunyang Wang
Keyword(s):  
Diabetes Mellitus ◽  
Low Dose ◽  
Meta Analysis ◽  
Quality Data ◽  
Cochrane Library ◽  
Knowledge Infrastructure ◽  
Dose Aspirin ◽  
Increased Risk ◽  
Low Dose Aspirin ◽  
Patients With Diabetes

Background. Our aim was to assess the risk of gastrointestinal (GI) hemorrhage associated with diabetes among patients taking low-dose aspirin (≤325 mg/day). Methods. A systematic search was conducted for publication in English and Chinese using term equivalents for “GI hemorrhage”, “aspirin”, and “diabetes mellitus” up till April 2020. Electronic databases include PUBMED, EMBASE, Cochrane Library databases, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database. Two independent authors searched databases and reviewed abstracts for comprehensive studies keeping adequate study quality. Data of weighted odds ratios were statistically evaluated and potential bias was checked. Results. Among 446 publications, eight case-control researches, including 1601 patients, were deemed for this meta-analysis. Patients with diabetes were associated with a higher risk of GI hemorrhage than patients without diabetes: the summary ORs were 3.10 (95% CI, 2.35–4.09). The heterogeneity of the reports was not significant (Chi2=3.39, P=0.85; I2=0%). Conclusion. The meta-analysis showed that aspirin users with diabetes were more likely to have GI hemorrhage. Hence, when treating diabetics with aspirin, the increased risk of GI bleeding should be taken in consideration.

scholarly journals 48: Effect of obesity on platelet inhibition in high-risk pregnant women treated with low dose aspirin

2019 ◽  
Vol 220 (1) ◽  
pp. S38-S39 ◽  
Author(s):  
Matthew M. Finneran ◽  
Veronica M. Gonzalez-Brown ◽  
Devin D. Smith ◽  
Mark B. Landon ◽  
Kara Rood
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Low Dose ◽  
Platelet Inhibition ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals 175: Effect of body size on preeclampsia risk-reducing potential of low-dose aspirin among high-risk pregnant women

2020 ◽  
Vol 222 (1) ◽  
pp. S124-S125
Author(s):  
James Lasky ◽  
Roxane Handal-Orefice ◽  
Desmond Sutton ◽  
Sheila Nemeth ◽  
Alexander M. Friedman ◽  
...  
Keyword(s):  
Body Size ◽  
High Risk ◽  
Pregnant Women ◽  
Low Dose ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Risk Reducing ◽  
Reducing Potential

scholarly journals Effect of low dose aspirin on fetal outcome in women at risk for developing pregnancy induced hypertension

2020 ◽  
Vol 7 (4) ◽  
pp. 865
Author(s):  
Madhusmita Pradhan ◽  
Jyotiranjan Champatiray ◽  
Kishore V. S.
Keyword(s):  
Birth Weight ◽  
High Risk ◽  
Low Birth Weight ◽  
Pregnant Women ◽  
Gestational Age ◽  
Low Dose ◽  
Pregnancy Induced Hypertension ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Induced Hypertension

Background: Though pregnancy induced hypertension is a worldwide problem, it is more prevalent in developing countries particularly south east Asian and African countries. It contributes to 20% of perinatal death and 40-50% of low birth weight babies in India. Fetal salvage is also an important consideration in providing quality care. Low dose aspirin given between 12 weeks to 28 weeks of gestational age in high-risk women at Developing Pregnancy Induced Hypertension (PIH) is anticipated to prevent the development of PIH and complications that arises especially those regarding maternal and fetal mortality due to PIH.Methods: This prospective randomized controlled trial was conducted in the dept of O and G, SCB MC and Hospital, Cuttack during November 2018 to October 2019. Pregnant women between the gestational age of 13 to 28 week were screened for risk factors and included in this study. Low dose aspirin of 60 mg daily till delivery was given to pregnant women who consented to be a part of study randomly with the other group taking placebo.Results: Incidence of IUGR babies in low dose aspirin treated mothers was as low as 1%. Incidence of LBW babies is lower in low dose aspirin treated mothers than with those who were not treated. Mean birth weight in cases was 2780 gm±352 gm vs control 2592 gm±483 gm. There is increased incidence of still birth in high risk group not treated with aspirin. No significant difference in reducing incidence premature deliveries between case and control.Conclusions: Low dose aspirin has a definite role in the prevention of PIH in high risk pregnancy and its complication like IUGR and low birth weight. Low dose aspirin reduces the incidence of PIH. Low dose aspirin can be considered a safe drug without any deleterious side effect for mother and the fetus. Benefits of prevention of PIH, justifies its administration in women at high risk.

scholarly journals Effect of low dose aspirin on maternal outcome in women at risk for developing pregnancy induced hypertension

2020 ◽  
Vol 9 (4) ◽  
pp. 1590
Author(s):  
Madhusmita Pradhan ◽  
Kishore S. V. ◽  
Jyotiranjan Champatiray
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Pregnant Women ◽  
Low Dose ◽  
Multiple Pregnancy ◽  
Control Group ◽  
Pregnancy Induced Hypertension ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Induced Hypertension

Background: Pre-eclampsia is not totally a preventable disease. It is found more related to chains of social ills such as poor maternal nutrition, limited or no antenatal care and poor reproductive education. However, some specific “high-risk” factors leading to pregnancy induced hypertension (PIH) may be identified in individuals which include and not limited to young and elderly primigravida, multiple pregnancy, diabetes, Rh incompatibility, new paternity, pre-existing vascular or renal disease, family history of hypertension, pre-eclampsia and eclampsia, obesity, thrombophilia. Low dose aspirin given in 2nd trimester in these high-risk women is anticipated to prevent the development of PIH.Methods: This prospective randomized controlled trial was conducted in the department of obstetrics and gynecology, SCB MC and Hospital, Cuttack during November 2018 to October 2019. Pregnant women between the gestational age of 13th to 28th weeks were screened for risk factors and included in this study. Low dose aspirin of 60 mg daily till delivery was given to pregnant women who consented to be a part of study randomly with the other group having placebo.Results: Protienuric hypertension was high in control group who did not receive aspirin. Low dose aspirin significantly reduces PIH in high-risk group (3.48% in case versus 23.52% in control). Low dose aspirin was not associated with significant increase in placental bleeding. Low dose aspirin was generally safe for the fetus and new born infant with no evidence of an increased likelihood of bleeding.Conclusions: Low dose aspirin has a definite role in the prevention of PIH in high risk pregnancy. Low dose aspirin reduces the incidence of PIH. Low dose aspirin can be considered a safe drug without any deleterious side effect for mother and the fetus. Benefits of prevention of PIH, justifies its administration in women at high risk.

ASPIRIN ADMINISTRATION FOR PREVENTION OF ADVERSE PREGNANCY OUTCOMES

2012 ◽  
Vol 23 (3-4) ◽  
pp. 187-200 ◽  
Author(s):  
EMMANUEL BUJOLD ◽  
STÉPHANIE ROBERGE ◽  
SUZANNE DEMERS ◽  
KYPROS H NICOLAIDES
Keyword(s):  
High Risk ◽  
Low Dose ◽  
Meta Analysis ◽  
Research Question ◽  
High Risk Women ◽  
Dose Aspirin ◽  
Nulliparous Women ◽  
Low Dose Aspirin ◽  
Prophylactic Use ◽  
Adverse Pregnancy

The prophylactic use of low-dose aspirin for prevention of preeclampsia has been an important research question in obstetrics for the last three decades. In 1979, Crandon and Isherwood observed that nulliparous women who had taken aspirin regularly during pregnancy were less likely to have preeclampsia than women who did not. In 1985, Beaufils et al published the first randomized trial suggesting that 150 mg aspirin and 300 mg dipyridamole daily from 3 months’ gestation onwards decreased the risk of preeclampsia, fetal growth restriction and stillbirth in high-risk women. Subsequently, more than 50 trials have been carried out throughout the world and a meta-analysis of these studies reported that the administration of low-dose aspirin in high-risk pregnancies is associated with a decrease in the rate of preeclampsia by approximately 10%. Consequently, several national professional bodies recommend that high-risk pregnancies should be treated with aspirin (50–150 mg daily).

scholarly journals Prognostic and therapeutic role of vitamin D in COVID-19: systematic review and meta-analysis

2021 ◽  
Author(s):  
Harsha Anuruddhika Dissanayake ◽  
Nipun Lakshitha de Silva ◽  
Manilka Sumanatilleke ◽  
Sawanawadu Dilantha Neomal de Silva ◽  
Kavinga Kalhari Kobawaka Gamage ◽  
...  
Keyword(s):  
Vitamin D ◽  
High Risk ◽  
Vitamin D Deficiency ◽  
Observational Studies ◽  
Meta Analysis ◽  
Severe Disease ◽  
Risk Of Bias ◽  
Sensitivity Analyses ◽  
Cochrane Library

Abstract Purpose Vitamin D deficiency/insufficiency may increase the susceptibility to COVID-19. We aimed to determine the association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, its severity, mortality and role of vitamin D in its treatment. Methods We searched CINHAL, Cochrane library, EMBASE, PubMED, Scopus, and Web of Science up to 30.05.2021 for observational studies on association between vitamin D deficiency/insufficiency and susceptibility to COVID-19, severe disease and death among adults, and, randomized controlled trials (RCTs) comparing vitamin D treatment against standard care or placebo, in improving severity or mortality among adults with COVID-19. Risk of bias was assessed using Newcastle-Ottawa scale for observational studies and AUB-KQ1 Cochrane tool for RCTs. Study-level data were analyzed using RevMan 5.3 and R (v4∙1∙0). Heterogeneity was determined by I  2 and sources were explored through pre-specified sensitivity analyses, subgroup analyses and meta-regressions. Results Of 1877 search results, 76 studies satisfying eligibility criteria were included. Seventy-two observational studies were included in the meta-analysis (n=1976099). Vitamin D deficiency/insufficiency increased the odds of developing COVID-19 (OR 1∙46, 95% CI 1∙28–1∙65, p<0∙0001, I  2=92%), severe disease (OR 1∙90, 95% CI 1∙52–2∙38, p<0.0001, I  2=81%) and death (OR 2∙07, 95% CI 1∙28–3∙35, p=0.003, I  2=73%). 25-hydroxy vitamin D (25(OH)D) concentration were lower in individuals with COVID-19 compared to controls (mean difference [MD] -3∙85 ng/mL, 95% CI -5∙44,-2∙26, p=<0.0001), in patients with severe COVID-19 compared to controls with non-severe COVID19 (MD -4∙84 ng/mL, 95% CI -7∙32,-2∙35, p=0∙0001) and in non-survivors compared to survivors (MD -4∙80 ng/mL, 95%-CI -7∙89,-1∙71, p=0∙002). The association between vitamin D deficiency/insufficiency and death was insignificant when studies with high risk of bias or studies reporting unadjusted effect estimates were excluded. Risk of bias and heterogeneity were high across all analyses. Discrepancies in timing of vitamin D testing, definitions of severe COVID-19 and vitamin D deficiency/insufficiency partly explained the heterogeneity. Four RCTs were widely heterogeneous precluding meta-analysis. Conclusion Multiple observational studies involving nearly two million adults suggest vitamin D deficiency/insufficiency increases susceptibility to COVID-19 and severe COVID-19, although with a high risk of bias and heterogeneity. Association with mortality was less robust. Heterogeneity in RCTs precluded their meta-analysis.

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