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Anticoagulation regimens during pregnancy in patients with mechanical heart valves: a protocol for a systematic review and network meta-analysis
  1. Shiwei He1,
  2. Yue Zou1,
  3. Juan Li2,
  4. Jumei Liu2,
  5. Li Zhao3,
  6. Hua Yang4,
  7. Zhiying Su4,
  8. Huiming Ye1,2,3
  1. 1 School of Public Health, Xiamen University, Xiamen, China
  2. 2 Department of Clinical Laboratory, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
  3. 3 School of Medicine, Xiamen University, Xiamen, China
  4. 4 Department of Obstetrics, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, China
  1. Correspondence to Dr. Huiming Ye; yehuiming{at}; Professor Zhiying Su; dyyyszy{at}


Introduction Pregnancy in patients with mechanical heart valves (MHVs) is associated with high maternal complications and fetal complications.Anticoagulation treatments serve to decrease their venous clotting risk. Although some anticoagulation regimens have been used for patients during pregnancy with MHVs, no one is definitively superior among different regimens in recent studies. For a better understanding of the clinical treatment which anticoagulation regimen is more effective and safer during the pregnancy in patients with MHVs, a Bayesian network meta-analysis is necessary.

Methods and analysis This protocol has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Related studies until April 2019 will be searched in the following databases: PubMed, Embase,SinoMed and the using the OVID interface to search for evidence-based medicine reviews. A clinical trial registry ( was also searched for unpublished trials. Both experimental studies (randomised clinical trials) and observational studies (cohort studies, case–control studies and case series studies) will be included in this study. Quality assessment will be conducted using Cochrane Collaboration’s tool or Newcastle-Ottawa Scale based on their study designs. The primary outcomes of interest will be the frequencies of serious maternal and fetal events. The additional outcomes of interest will be adverse maternal events, mode of delivery and adverse fetal events. Pairwise and network meta-analysis will be conducted using R (V.3.4.4, R Foundation for Statistical Computing, Vienna, Austria) and Stata (V.14, StataCorp). The ranking probabilities will be estimated at each possible rank for each anticoagulation regimen using the surface under the cumulative ranking curve. Statistical inconsistency assessment, subgroup analysis, sensitivity analysis and publication bias assessment will be performed.

Ethics and dissemination Either ethics approval or patient consent is not necessary, because this study will be based on literature. The results of this study will be published in a peer-reviewed journal.

PROSPERO registration number CRD42019130659

  • pregnancy
  • mechanical heart valves
  • anticoagulation regimens
  • network meta-analysis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors SH and HY are responsible for the conception of the protocol. SH, YZ, JLi, JLiu, LZ and HY were involved in the design of this protocol. SH, YZ,JLi and JLiu tested the feasibility of this protocol. SH, YZ and JLi wrote the original draft. HY, ZS and HY reviewed the draft and approved the final manuscript as submitted. All authors contributed to the development of the selection criteria. All authors read, provided feedback and approved the final manuscript as submitted.

  • Funding This study was supported by the National Natural Science Foundation of China (81472031, 81101331) and Foundation of Fujian Provincial Health System for Outstanding Young Doctors (2015-WZK-ZD-32) and Xiamen Youth Innovation Talents Project (2015-A-03).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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