Terapia con acetilsalicilico y heparina de bajo peso molecular para desenlaces obstetricos: Revision-Metaanalisis

El síndrome antifosfolípidos afecta al 1-5% de mujeres sanas en edad reproductiva, y se asocia con desenlaces obstétricos adversos: abortos espontáneos, perdidas recurrentes de la gestación, preeclampsia, restricción del crecimiento fetal y parto pretérmino. La evidencia disponible aún no permite es...

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Autores:
Mosquera Agudelo, Jose Luis
Tipo de recurso:
https://purl.org/coar/resource_type/c_7a1f
Fecha de publicación:
2025
Institución:
Universidad El Bosque
Repositorio:
Repositorio U. El Bosque
Idioma:
spa
OAI Identifier:
oai:repositorio.unbosque.edu.co:20.500.12495/15620
Acceso en línea:
https://hdl.handle.net/20.500.12495/15620
Palabra clave:
Àcido acetilsalicílico
Heparina bajo peso molecular
Síndrome Antifosfolipídico
Acetylsalicylic acid
Low molecular weight heparin
Antiphospholipid syndrome
WQ 200
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License
Attribution-NonCommercial-NoDerivatives 4.0 International
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oai_identifier_str oai:repositorio.unbosque.edu.co:20.500.12495/15620
network_acronym_str UNBOSQUE2
network_name_str Repositorio U. El Bosque
repository_id_str
dc.title.none.fl_str_mv Terapia con acetilsalicilico y heparina de bajo peso molecular para desenlaces obstetricos: Revision-Metaanalisis
dc.title.translated.none.fl_str_mv Therapy with Acetylsalicylic Acid and Low-Molecular-Weight Heparin for Obstetric Outcomes: Review–Meta-Analysis
title Terapia con acetilsalicilico y heparina de bajo peso molecular para desenlaces obstetricos: Revision-Metaanalisis
spellingShingle Terapia con acetilsalicilico y heparina de bajo peso molecular para desenlaces obstetricos: Revision-Metaanalisis
Àcido acetilsalicílico
Heparina bajo peso molecular
Síndrome Antifosfolipídico
Acetylsalicylic acid
Low molecular weight heparin
Antiphospholipid syndrome
WQ 200
title_short Terapia con acetilsalicilico y heparina de bajo peso molecular para desenlaces obstetricos: Revision-Metaanalisis
title_full Terapia con acetilsalicilico y heparina de bajo peso molecular para desenlaces obstetricos: Revision-Metaanalisis
title_fullStr Terapia con acetilsalicilico y heparina de bajo peso molecular para desenlaces obstetricos: Revision-Metaanalisis
title_full_unstemmed Terapia con acetilsalicilico y heparina de bajo peso molecular para desenlaces obstetricos: Revision-Metaanalisis
title_sort Terapia con acetilsalicilico y heparina de bajo peso molecular para desenlaces obstetricos: Revision-Metaanalisis
dc.creator.fl_str_mv Mosquera Agudelo, Jose Luis
dc.contributor.advisor.none.fl_str_mv Romero Infante , Ximena Carolina
De la Hoz Valle , Jose
Reyes, Guillermo Ivan
Sarmiento Hernandez, Diana Piedad
dc.contributor.author.none.fl_str_mv Mosquera Agudelo, Jose Luis
dc.contributor.orcid.none.fl_str_mv 0000-0002-2477-7426
dc.subject.none.fl_str_mv Àcido acetilsalicílico
Heparina bajo peso molecular
Síndrome Antifosfolipídico
topic Àcido acetilsalicílico
Heparina bajo peso molecular
Síndrome Antifosfolipídico
Acetylsalicylic acid
Low molecular weight heparin
Antiphospholipid syndrome
WQ 200
dc.subject.keywords.none.fl_str_mv Acetylsalicylic acid
Low molecular weight heparin
Antiphospholipid syndrome
dc.subject.nlm.none.fl_str_mv WQ 200
description El síndrome antifosfolípidos afecta al 1-5% de mujeres sanas en edad reproductiva, y se asocia con desenlaces obstétricos adversos: abortos espontáneos, perdidas recurrentes de la gestación, preeclampsia, restricción del crecimiento fetal y parto pretérmino. La evidencia disponible aún no permite establecer un consenso sobre la efectividad del tratamiento en la reducción de estos desenlaces en mujeres embarazadas. Objetivos: Evaluar la efectividad del tratamiento con ácido acetilsalicílico en comparación con heparina bajo peso molecular o su uso combinado en pacientes embarazadas con SAF en la disminución de desenlaces adversos obstétricos. Métodos: revisión sistemática de la literatura; búsqueda en las bases de datos MEDLINE, PubMed, Scopus y Web of Science hasta el 19/09/2024. Registro: CRD42024495443. Los datos relevantes fueron tabulados y procesados en Stata®. Las participantes se agruparon según el tratamiento recibido (ASA, HBPM o combinación) y la presencia de desenlaces obstétricos adversos. Resultados: se incluyeron 10 estudios, 5 ensayos y 5 estudios de cohorte, con un total de 1,119 gestantes. La combinación de ASA y HBPM se asoció con una reducción significativa del riesgo de aborto frente al uso exclusivo de ASA (RR en ECA = 2.15 [IC95%: 1.09–4.23]; RR en cohortes = 3.63 [IC95%: 1.36–9.70]). Los estudios de cohorte sugieren una mayor tasa de Nacidos vivos (NV)(RR = 0.80 [IC 95%: 0.67 -- 0.97]). Conclusiones: El metaanálisis analizó de forma integral múltiples desenlaces obstétricos adversos, evidenciando que el tratamiento combinado redujo significativamente el riesgo de complicaciones materno-perinatales en comparación con el uso exclusivo de ASA.
publishDate 2025
dc.date.accessioned.none.fl_str_mv 2025-08-01T13:58:47Z
dc.date.available.none.fl_str_mv 2025-08-01T13:58:47Z
dc.date.issued.none.fl_str_mv 2025-07
dc.type.coar.fl_str_mv http://purl.org/coar/resource_type/c_7a1f
dc.type.local.spa.fl_str_mv Tesis/Trabajo de grado - Monografía - Especialización
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dc.type.driver.none.fl_str_mv info:eu-repo/semantics/bachelorThesis
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dc.identifier.instname.spa.fl_str_mv instname:Universidad El Bosque
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional Universidad El Bosque
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language spa
dc.relation.references.none.fl_str_mv 1. Chighizola, C. B., de Jesus, G. R., & Branch, D. W. (2016). The role of the complement system in the antiphospholipid syndrome. Lupus, 25(4), 402–405
2. Giannakopoulos, B., & Krilis, S. A. (2013). The pathogenesis of the antiphospholipid syndrome. New England Journal of Medicine, 368(11), 1033–1044
3. Branch, D. W., & Khamashta, M. A. (2011). Antiphospholipid syndrome: Obstetric diagnosis, management, and controversies. Obstetrics & Gynecology, 117(4), 895–906.
4. Mak, A., Cheung, M. W. L., Cheak, A. A. C., & Ho, R. C. M. (2010). Combination of heparin and aspirin is more effective than aspirin alone in the treatment of antiphospholipid syndrome in pregnancy: A meta-analysis. Autoimmunity Reviews, 9(8), 512–517.
5. Rai, R., Cohen, H., Dave, M., Regan, L. (1997). Randomized controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or lupus anticoagulant). BMJ, 314(7076), 253–257.
6. Farquharson, R. G., Quenby, S., & Greaves, M. (2002). Antiphospholipid syndrome in pregnancy: A randomized, controlled trial of treatment. Obstetrics and Gynecology, 100(3), 408–413. https://doi.org/10.1016/s0029-7844(02)02165-8
7. Visser, J., Ulander, V. M., Helmerhorst, F. M., & Koster, T. (2011). Low-dose aspirin in women with recurrent miscarriage. BJOG: An International Journal of Obstetrics & Gynaecology, 118(6), 674–680.
8. Empson, M., Lassere, M., Craig, J., & Scott, J. (2005). Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database of Systematic Reviews, 2005(2), CD002859.
9. Bouvier, S., Cochery-Nouvellon, E., Lavigne-Lissalde, G., Mercier, E., Gris, J. C., & the NOHA First-line Study Group. (2022). Antiphospholipid syndrome and pregnancy: Guidelines and recommendations. Thrombosis Research, 211, S31–S37.
10. Cervera, R., Piette, J. C., Font, J., Khamashta, M. A., Shoenfeld, Y., Camps, M. T., et al. (2002). Antiphospholipid syndrome: Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis & Rheumatism, 46(4), 1019–1027.
11. Alijotas-Reig, J., Esteve-Valverde, E., Ferrer-Oliveras, R., Sáez-Comet, L., Lefkou, E., Mekinian, A., et al. (2019). The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): A survey of 1000 consecutive cases. Autoimmunity Reviews, 18(4), 406–414. https://doi.org/10.1016/j.autrev.2018.12.006
12. Knight, J. S., Kanthi, Y., & Moore, B. J. (2023). Emerging insights in antiphospholipid syndrome: From pathogenesis to targeted therapy. Nature Reviews Rheumatology, 19(1), 45–59.
13. Miyakis, S., Lockshin, M. D., Atsumi, T., Branch, D. W., Brey, R. L., Cervera, R., et al. (2006). International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). Journal of Thrombosis and Haemostasis, 4(2), 295–306.
14. Revista Colombiana de Reumatología. (2021). Guía de práctica clínica para el diagnóstico y manejo del síndrome antifosfolípido.
15. Erkan, D., & Lockshin, M. D. (2020). APS ACTION–keeping the focus on patients. Lupus Science & Medicine, 7(1), e000381.
16. American College of Obstetricians and Gynecologists (ACOG). (2012). Practice Bulletin No. 132: Antiphospholipid syndrome. Obstetrics & Gynecology, 120(6), 1514–1521.
17. Di Simone, N., Di Nicuolo, F., D’Ippolito, S., Castellani, R., Tersigni, C., & Caruso, A. (2003). Antiphospholipid antibodies affect human trophoblast gene expression: A functional genomics approach. American Journal of Reproductive Immunology, 49(4), 214–221.
18. Cervera, R., & Espinosa, G. (2006). Antiphospholipid syndrome and pregnancy. Rheumatic Disease Clinics of North America, 32(3), 641–657.
19. Alijotas-Reig, J., Esteve-Valverde, E., Ferrer-Oliveras, R., & Ruffatti, A. (2022). Controversies in the management of obstetric antiphospholipid syndrome: A comprehensive review. *Autoimmunity Reviews*, 21(2), 103018. https://doi.org/10.1016/j.autrev.2021.103018
20. Zhou, H., Chen, Y., Zhang, L., & Liu, Y. (2010). Heparin therapy for women with recurrent miscarriage: A meta-analysis. Archives of Gynecology and Obstetrics, 281(6), 861–871.
21. Pons-Estel, G. J., Andreoli, L., Scanzi, F., Cervera, R., & Tincani, A. (2017). The antiphospholipid syndrome in patients with systemic lupus erythematosus. Journal of Autoimmunity, 76, 10–20.
22. Branch, D. W., Gibson, M., Silver, R. M., Mitchell, M. D., & the Antiphospholipid Antibody Study Group. (2011). Outcomes of treated pregnancies in women with antiphospholipid syndrome: A multicenter, prospective study. American Journal of Obstetrics and Gynecology, 204(3), 234.e1–234.e5.
23. Cohen, D., Berger, S. P., Steup-Beekman, G. M., Bloemenkamp, K. W., & Bajema, I. M. (2018). Diagnosis and management of the antiphospholipid syndrome. BMJ, 363, k5129.
24. Giannakopoulos, B., & Krilis, S. A. (2022). Pathogenesis of the antiphospholipid syndrome. Autoimmunity Reviews, 21(7), 103112.
25. Lockshin, M. D., Druzin, M. L., Goei, S., Qamar, T., Magid, M. S., & Estes, D. (1992). Antibody to phospholipid and trophoblast in habitual abortion. Journal of Reproductive Immunology, 22(2), 151–160.
26. Silver, R. M., Parker, C. B., Reddy, U. M., Goldenberg, R., Pinar, H., Dudley, D. J., et al. (2012). Antiphospholipid antibodies in stillbirth. Obstetrics and Gynecology, 119(4), 795–801.
27. Urbanski, G., Clark, E., & Laing, S. (2012). Obstetric complications in patients with antiphospholipid syndrome. Rheumatology International, 32(2), 403–410.
28. Mekinian, A., Vicaut, E., Lachassinne, E., Nicaise-Roland, P., Carbillon, L., Kayem, G., et al. (2020). Fetal and maternal outcomes in obstetric antiphospholipid syndrome treated with low molecular weight heparin: A meta-analysis. Autoimmunity Reviews, 19(2), 102462.
29. Erkan, D., & Lockshin, M. D. (2011). APS treatment: Using evidence to guide clinical practice. Rheumatic Disease Clinics of North America, 37(3), 345–359.
30. Clark, C. A., Spitzer, K. A., Laskin, C. A., & the APS ACTION Network. (2020). Antiphospholipid antibody syndrome and recurrent pregnancy loss: What’s new? Current Opinion in Obstetrics and Gynecology, 32(4), 257–264.
31. Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2019). Cochrane Handbook for Systematic Reviews of Interventions (2nd ed.). Cochrane. https://training.cochrane.org/handbook
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34. World Medical Association. (2013). Declaración de Helsinki – Principios éticos para las investigaciones médicas en seres humanos.
35. Kutteh, W. H. (1996). Antiphospholipid antibody–associated recurrent pregnancy loss: Treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. American Journal of Obstetrics and Gynecology, 174(5), 1584–1589. https://doi.org/10.1016/s0002-9378(96)70610-5
36. Serrano, F., Nogueira, I., Borges, A., & Branco, J. (2009). Primary antiphospholipid syndrome: Pregnancy outcome in a Portuguese population. Acta Reumatológica Portuguesa, 34(3), 492–497.
37. Alalaf, S. (2012). Bemiparin versus low dose aspirin for management of recurrent early pregnancy losses due to antiphospholipid antibody syndrome. Archives of Gynecology and Obstetrics, 285(3), 641–647. https://doi.org/10.1007/s00404-011-2055-y
38. Ozaki, Y., Yoshihara, H., Sugiura-Ogasawara, M., Kitaori, T., & Katano, K. (2020). Danaparoid is effective and safe for patients with obstetric antiphospholipid syndrome. Modern Rheumatology, 30(2), 332–337. https://doi.org/10.1080/14397595.2019.1602241
39. Laskin, C. A., Spitzer, K. A., Clark, C. A., Crowther, M. R., Ginsberg, J. S., Hawker, G. A., et al. (2009). Low molecular weight heparin and aspirin for recurrent pregnancy loss: Results from the randomized, controlled HepASA Trial. Journal of Rheumatology, 36(2), 279–287. https://doi.org/10.3899/jrheum.080763
40. Wang, J., Zhang, L., Li, X., He, Y., Wen, X., Xu, N., et al. (2023). Maternal and perinatal outcomes of low-dose aspirin plus low-molecular-weight heparin therapy on antiphospholipid antibodypositive pregnant women with chronic hypertension. Frontiers in Pediatrics, 11, 1148547.https://doi.org/10.3389/fped.2023.1148547
41. Eid, M. I., Abdelhafez, M. S., El-refaie, W., El-Zayadi, A. A., Samir, K., Abdelrazik, M. M., et al. (2019). Timing of initiation of low-molecular-weight heparin administration in pregnant women with antiphospholipid syndrome: A randomized clinical trial of efficacy and safety. International Journal of Women’s Health, 11, 41–47. https://doi.org/10.2147/ijwh.s193293
42. Mohamed, K. A. A., & Saad, A. S. (2014). Enoxaparin and aspirin therapy for recurrent pregnancy loss due to anti-phospholipid syndrome (APS). Middle East Fertility Society Journal, 19(3), 176–182. https://doi.org/10.1016/j.mefs.2013.12.004
43. Schreiber, K., & Hunt, B. J. (2019). Managing antiphospholipid syndrome in pregnancy. *Thrombosis Research*, 181, S41–S46. https://doi.org/10.1016/S0049-3848(19)30355-5
44. Liu, X., Zhang, X., Wang, Y., Chen, H., & Liu, Y. (2020). Maternal and fetal outcomes in pregnant women with antiphospholipid syndrome: A systematic review and meta-analysis. *Autoimmunity Reviews*, 19(3), 102490. https://doi.org/10.1016/j.autrev.2020.102490
45. El Hasbani, G., Abou Taka, H., Sakr, A., Uthman, I., & Zaidan, M. (2020). Antiphospholipid syndrome and pregnancy: Can we improve the outcomes? *Immunologic Research*, 68(5), 334–344. https://doi.org/10.1007/s12026-020-09134-7
46. Tektonidou, M. G., Andreoli, L., Limper, M., Amoura, Z., Cervera, R., Costedoat-Chalumeau, N., et al. (2019). EULAR recommendations for the management of antiphospholipid syndrome in adults. *Annals of the Rheumatic Diseases*, 78(10), 1296–1304. https://doi.org/10.1136/annrheumdis2019-215213
47. Pattison, N. S., Chamley, L. W., Birdsall, M., & McCowan, L. (2000). Does aspirin have a role in improving pregnancy outcome for women with the lupus anticoagulant? A randomized controlled trial. *American Journal of Obstetrics and Gynecology*, 183(5), 1008–1012. https://doi.org/10.1067/mob.2000.109093
48. Hamulyák, E. N., Scheres, L. J., van Walraven, S. M., Meijer, K., & Middeldorp, S. (2020). Antithrombotic therapy in women with antiphospholipid antibodies or antiphospholipid syndrome. *Blood Reviews*, 43, 100653. https://doi.org/10.1016/j.blre.2020.100653
49. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. *International Journal of Surgery*, 8(5), 336–341. https://doi.org/10.1016/j.ijsu.2010.02.007
50. Cabello, J. B. (2005). Anticoagulantes para el tratamiento de la trombosis venosa profunda. *Cochrane Database of Systematic Reviews*, (3). https://doi.org/10.1002/14651858.CD003290.pub2
51. da Rosa, G. A., Dos Santos, B. M., Nunes, C. R., & Pires da Rosa, M. I. (2022). Use of heparin in pregnancy: A systematic review and meta-analysis. *Journal of Maternal-Fetal & Neonatal Medicine*, 35(1), 30–36. https://doi.org/10.1080/14767058.2020.1749241
52. Sammaritano, L. R., Bermas, B. L., Chakravarty, E. E., Chambers, C., Clowse, M. E. B., Lockshin, M. D., et al. (2020). 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. *Arthritis & Rheumatology*, 72(4), 529–556. https://doi.org/10.1002/art.41191
53. Ziakas, P. D., Pavlou, M., Voulgarelis, M., & Moutsopoulos, H. M. (2010). Heparin treatment in antiphospholipid syndrome with recurrent pregnancy loss: A systematic review and meta-analysis. *Obstetrics and Gynecology*, 115(6), 1256–1262. https://doi.org/10.1097/AOG.0b013e3181df93d2
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spelling Romero Infante , Ximena CarolinaDe la Hoz Valle , JoseReyes, Guillermo IvanSarmiento Hernandez, Diana PiedadMosquera Agudelo, Jose Luis0000-0002-2477-74262025-08-01T13:58:47Z2025-08-01T13:58:47Z2025-07https://hdl.handle.net/20.500.12495/15620instname:Universidad El Bosquereponame:Repositorio Institucional Universidad El Bosquerepourl:https://repositorio.unbosque.edu.coEl síndrome antifosfolípidos afecta al 1-5% de mujeres sanas en edad reproductiva, y se asocia con desenlaces obstétricos adversos: abortos espontáneos, perdidas recurrentes de la gestación, preeclampsia, restricción del crecimiento fetal y parto pretérmino. La evidencia disponible aún no permite establecer un consenso sobre la efectividad del tratamiento en la reducción de estos desenlaces en mujeres embarazadas. Objetivos: Evaluar la efectividad del tratamiento con ácido acetilsalicílico en comparación con heparina bajo peso molecular o su uso combinado en pacientes embarazadas con SAF en la disminución de desenlaces adversos obstétricos. Métodos: revisión sistemática de la literatura; búsqueda en las bases de datos MEDLINE, PubMed, Scopus y Web of Science hasta el 19/09/2024. Registro: CRD42024495443. Los datos relevantes fueron tabulados y procesados en Stata®. Las participantes se agruparon según el tratamiento recibido (ASA, HBPM o combinación) y la presencia de desenlaces obstétricos adversos. Resultados: se incluyeron 10 estudios, 5 ensayos y 5 estudios de cohorte, con un total de 1,119 gestantes. La combinación de ASA y HBPM se asoció con una reducción significativa del riesgo de aborto frente al uso exclusivo de ASA (RR en ECA = 2.15 [IC95%: 1.09–4.23]; RR en cohortes = 3.63 [IC95%: 1.36–9.70]). Los estudios de cohorte sugieren una mayor tasa de Nacidos vivos (NV)(RR = 0.80 [IC 95%: 0.67 -- 0.97]). Conclusiones: El metaanálisis analizó de forma integral múltiples desenlaces obstétricos adversos, evidenciando que el tratamiento combinado redujo significativamente el riesgo de complicaciones materno-perinatales en comparación con el uso exclusivo de ASA.Especialista en Medicina Materno-FetalEspecializaciónAntiphospholipid Syndrome affects 1–5% of healthy women of reproductive age and is associated with adverse obstetric outcomes such as spontaneous miscarriages, recurrent pregnancy loss, preeclampsia, fetal growth restriction, and preterm birth. Current evidence does not yet allow for a consensus on the effectiveness of treatment in reducing these outcomes in pregnant women. Objectives: To evaluate the effectiveness of treatment with acetylsalicylic acid compared to low molecular weight heparin or their combined use in pregnant patients with APS in reducing adverse obstetric outcomes. Methods: A search strategy was carried out in the MEDLINE, PubMed, Scopus, and Web of Science databases up to (09/19/2024), under registration number: CRD42024495443. Relevant data were tabulated and processed using Stata®️. Participants were grouped according to the treatment received (ASA, LMWH, or combination) and the presence of adverse obstetric outcomes. Results: Ten studies were included (5 trials and 5 cohort studies), totaling 1,119 pregnant women. The combination of ASA and LMWH was associated with a significant reduction in the risk of miscarriage compared to ASA alone (RR in RCTs = 2.15 [95% CI: 1.09–4.23]; RR in cohorts = 3.63 [95% CI: 1.36–9.70]). Cohort studies suggest a higher rate of live birth (RR = 0.80 [95% CI: 0.67–0.97]). Conclusions: The meta-analysis comprehensively analyzed multiple adverse obstetric outcomes, showing that combined treatment was associated with a significant reduction in the risk of maternalperinatal complications compared to ASA alone.application/pdfAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/Acceso abiertohttps://purl.org/coar/access_right/c_abf2http://purl.org/coar/access_right/c_abf2Àcido acetilsalicílicoHeparina bajo peso molecularSíndrome AntifosfolipídicoAcetylsalicylic acidLow molecular weight heparinAntiphospholipid syndromeWQ 200Terapia con acetilsalicilico y heparina de bajo peso molecular para desenlaces obstetricos: Revision-MetaanalisisTherapy with Acetylsalicylic Acid and Low-Molecular-Weight Heparin for Obstetric Outcomes: Review–Meta-AnalysisEspecialización en Medicina Materno-FetalUniversidad El BosqueFacultad de MedicinaTesis/Trabajo de grado - Monografía - Especializaciónhttps://purl.org/coar/resource_type/c_7a1fhttp://purl.org/coar/resource_type/c_7a1finfo:eu-repo/semantics/bachelorThesishttps://purl.org/coar/version/c_ab4af688f83e57aa1. 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Heparin treatment in antiphospholipid syndrome with recurrent pregnancy loss: A systematic review and meta-analysis. *Obstetrics and Gynecology*, 115(6), 1256–1262. https://doi.org/10.1097/AOG.0b013e3181df93d2spaORIGINALTrabajo de grado.pdfTrabajo de grado.pdfapplication/pdf1531226https://pruebas-update-repositorio-unbosque.cloudbiteca.com/bitstreams/7f022713-669c-41f6-9720-84471703a4a9/download32bfc5d0abac9b01a5bcd3cac707d8d4MD52trueAdministratorREADLICENSElicense.txtlicense.txttext/plain; charset=utf-82000https://pruebas-update-repositorio-unbosque.cloudbiteca.com/bitstreams/53d29f41-31da-42cd-a48e-c7de57b3fef7/download17cc15b951e7cc6b3728a574117320f9MD54falseAnonymousREADCarta de autorizacion.pdfapplication/pdf191561https://pruebas-update-repositorio-unbosque.cloudbiteca.com/bitstreams/027c65d2-bce7-41eb-b42a-d43c292e146a/download8859cddcf75ab58d4d79083cbe344310MD56falseBiblioteca - (Publicadores)READAnexo 1 acta de aprobacion.pdfapplication/pdf455540https://pruebas-update-repositorio-unbosque.cloudbiteca.com/bitstreams/f258e372-fde1-4126-bf70-906fcfdbcdce/download5fe1ae5d8c3f860e9873c43a92e25057MD59falseBiblioteca - (Publicadores)READCC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8899https://pruebas-update-repositorio-unbosque.cloudbiteca.com/bitstreams/b6b9fa83-cd47-4a9c-b36f-fbe65ad21a4c/download3b6ce8e9e36c89875e8cf39962fe8920MD55falseAnonymousREADTEXTTrabajo de grado.pdf.txtTrabajo de grado.pdf.txtExtracted texttext/plain78279https://pruebas-update-repositorio-unbosque.cloudbiteca.com/bitstreams/cee3910d-7a7c-41b7-8b04-c4212f6b5559/download28b992d0162ffa82682407910760c14fMD57falseAdministratorREADTHUMBNAILTrabajo de grado.pdf.jpgTrabajo de grado.pdf.jpgGenerated Thumbnailimage/jpeg4111https://pruebas-update-repositorio-unbosque.cloudbiteca.com/bitstreams/0551075d-9835-4809-aacd-6264556c8bff/downloadcd97c752e32278ed20bdb786e653cccbMD58falseAdministratorREAD20.500.12495/15620oai:pruebas-update-repositorio-unbosque.cloudbiteca.com:20.500.12495/156202025-08-04T21:45:10.175Zhttp://creativecommons.org/licenses/by-nc-nd/4.0/Attribution-NonCommercial-NoDerivatives 4.0 Internationalrestrictedhttps://pruebas-update-repositorio-unbosque.cloudbiteca.comRepositorio Institucional Universidad El Bosquebibliotecas@biteca.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