Women's values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review
Por:
Leon-Garcia, M, Humphries, B, Maraboto, A, Rabassa, M, Boehmer, KR, Perestelo-Perez, L, Xie, F, Pelayo, I, Eckman, M, Bates, S, Selva, A, Alonso-Coello, P
Publicada:
5 oct 2022
Ahead of Print:
5 oct 2022
Resumen:
Background 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. Methods 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. Results 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. Conclusions 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.
Filiaciones:
Leon-Garcia, M:
Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Univ Autonoma Barcelona, Dept Pediat Obstet Gynaecol & Prevent Med, Barcelona, Spain
Mayo Clin, Dept Med, Knowledge & Evaluat Res Unit, Rochester, MN USA
Humphries, B:
Cytel Inc, Toronto, ON, Canada
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
Maraboto, A:
Mayo Clin, Dept Med, Knowledge & Evaluat Res Unit, Rochester, MN USA
Rabassa, M:
Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Boehmer, KR:
Mayo Clin, Dept Med, Knowledge & Evaluat Res Unit, Rochester, MN USA
Mayo Clin, Div Hlth Care Delivery Res, Rochester, MN USA
Perestelo-Perez, L:
Canary Isl Hlth Serv SCS, Evaluat Unit SESCS, Tenerife, Spain
Res Network Hlth Serv Chron Dis REDISSEC, Tenerife, Spain
Network Res Chron Primary Care & Hlth Promot RICA, Tenerife, Spain
Xie, F:
McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada
McMaster Univ, Ctr Hlth Econ & Policy Anal, Hamilton, ON, Canada
Pelayo, I:
Ramon & Cajal Hosp, Dept Obstet & Gynecol, Madrid, Spain
Alcala de Henares Univ, Fac Med, Madrid, Spain
Eckman, M:
Univ Cincinnati, Sch Med, Div Gen Internal Med, Cincinnati, OH USA
Univ Cincinnati, Sch Med, Ctr Clin Effectiveness, Cincinnati, OH USA
Bates, S:
McMaster Univ, Dept Med, Hamilton, ON, Canada
Selva, A:
Univ Autonoma Barcelona, Dept Pediat Obstet Gynaecol & Prevent Med, Barcelona, Spain
Corp Sanitaria Parc Tauli, Clin Epidemiol & Canc Screening, Barcelona, Spain
Alonso-Coello, P:
Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
CIBERESP, CIBER Epidemiol & Publ Hlth, Madrid, Spain
gold, Green Submitted, Green Published
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