Women's values and preferences on low-molecular-weight heparin and pregnancy : a mixed-methods systematic review
León-García, Montserrat (Institut d'Investigació Biomèdica Sant Pau)
Humphries, Brittany (McMaster University (Canadà))
Maraboto, Andrea (Mayo Clinic (Rochester, Estats Units d'Amèrica))
Rabassa Bonet, Montserrat (Institut d'Investigació Biomèdica Sant Pau)
Boehmer, Kasey R. (Mayo Clinic (Rochester, Estats Units d'Amèrica))
Perestelo-Pérez, Lilisbeth (Servicio Canario de la Salud)
Xie, Feng (McMaster University (Canadà))
Pelayo, Irene (Universidad de Alcalá)
Eckman, Mark (University of Cincinnati School of Medicine (Estats Units d'Amèrica))
Bates, Shannon (McMaster University (Canadà))
Selva, A (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Alonso-Coello, Pablo (Institut d'Investigació Biomèdica Sant Pau)
Universitat Autònoma de Barcelona

Data:	2022
Resum:	Venous thromboembolism (VTE) in pregnancy is an important cause of maternal morbidity and mortality. Low-molecular-weight heparin (LMWH) is the cornerstone of prophylaxis and treatment of thrombotic events during pregnancy. LMWH has fewer adverse effects than other anticoagulants, does not cross the placenta, and is safe for the fetus. However, the use of LMWH during pregnancy is sensitive to womens' underlying preferences. The objective of this review is to systematically assess women's values and preferences research evidence on this topic. We searched four electronic databases from inception to March 2022, and included studies examining values and preferences of using LMWH among pregnant women at risk of VTE. We followed a convergent integrated mixed-methods design to compare and contrast quantitative outcomes (utility and non-utility measures) and qualitative findings. We assessed the certainty of the values and preferences evidence with the GRADE approach for quantitative findings, and with GRADE-CERqual for qualitative evidence. Results were presented in a conjoint display. We screened 3,393 references and identified seven eligible studies. The mixed methods analysis resulted in four themes. Datasets confirmed each other in that: 1) the majority of women consider that benefits of treatment outweigh the inconveniences of daily injections; and 2) main concerns around medication are safety and injections administration. Quantitative outcomes expanded on the qualitative findings in that: 3) participants who perceived a higher risk of VTE were more willing to take LMWH. Finally, we found a discrepancy between the datasets around: 4) the amount of information preferred to make the decision; however, qualitative data expanded to clarify that women prefer making informed decisions and receive support from their clinician in their decision-making process. We are moderately confident that in the context of pregnancy, using LMWH is preferred by women given its net beneficial balance. Integrating data from different sources of evidence, and representing them in a jointly manner helps to identify patient's values and preferences. Our results may inform clinical practice guidelines and support shared decision-making process in the clinical encounter for the management of VTE in the context of pregnancy. The online version contains supplementary material available at 10. 1186/s12884-022-05042-x.
Ajuts:	Instituto de Salud Carlos III PI17/01874
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Low-molecular-weight-heparin ; Pregnancy ; Values and preferences ; Venous thromboembolism
Publicat a:	BMC pregnancy and childbirth, Vol. 22 (october 2022) , ISSN 1471-2393

DOI: 10.1186/s12884-022-05042-x
PMID: 36199014

18 p, 1.8 MB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d’Investigació i Innovació Parc Taulí (I3PT)
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
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