{
    "abstract": "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.\nWe 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\u00a0outcomes (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.\nWe 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.\nWe 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.",
    "authors": [
        {
            "affiliation": "Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. mleong@santpau.cat.\nDepartment of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Aut\u00f3noma de Barcelona, Barcelona, Spain. mleong@santpau.cat.\nKnowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA. mleong@santpau.cat.",
            "firstname": "Montserrat",
            "initials": "M",
            "lastname": "Le\u00f3n-Garc\u00eda"
        },
        {
            "affiliation": "Cytel Inc, Toronto, ON, Canada.\nDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.",
            "firstname": "Brittany",
            "initials": "B",
            "lastname": "Humphries"
        },
        {
            "affiliation": "Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA.",
            "firstname": "Andrea",
            "initials": "A",
            "lastname": "Maraboto"
        },
        {
            "affiliation": "Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.",
            "firstname": "Montserrat",
            "initials": "M",
            "lastname": "Rabassa"
        },
        {
            "affiliation": "Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN, USA.\nDivision of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.",
            "firstname": "Kasey R",
            "initials": "KR",
            "lastname": "Boehmer"
        },
        {
            "affiliation": "Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain.\nResearch Network On Health Services in Chronic Diseases (REDISSEC), Tenerife, Spain.\nNetwork for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain.",
            "firstname": "Lilisbeth",
            "initials": "L",
            "lastname": "Perestelo-Perez"
        },
        {
            "affiliation": "Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.\nCentre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.",
            "firstname": "Feng",
            "initials": "F",
            "lastname": "Xie"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Ram\u00f3n y Cajal Hospital, Madrid, Spain.\nFaculty of Medicine, Alcal\u00e1 de Henares University, Madrid, Spain.",
            "firstname": "Irene",
            "initials": "I",
            "lastname": "Pelayo"
        },
        {
            "affiliation": "Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati School of Medicine, Cincinnati, OH, USA.",
            "firstname": "Mark",
            "initials": "M",
            "lastname": "Eckman"
        },
        {
            "affiliation": "Department of Medicine, McMaster University, Hamilton, ON, Canada.",
            "firstname": "Shannon",
            "initials": "S",
            "lastname": "Bates"
        },
        {
            "affiliation": "Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Aut\u00f3noma de Barcelona, Barcelona, Spain.\nClinical Epidemiology and Cancer Screening, Corporaci\u00f3 Sanitaria Parc Taul\u00ed, Sabadell, Barcelona, Spain.",
            "firstname": "Anna",
            "initials": "A",
            "lastname": "Selva"
        },
        {
            "affiliation": "Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.\nCIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain.",
            "firstname": "Pablo",
            "initials": "P",
            "lastname": "Alonso-Coello"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2022. The Author(s).",
    "doi": "10.1186/s12884-022-05042-x\n10.1002/ijgo.12764\n10.1177/1076029616675967\n10.1186/s12872-019-1183-3\n10.1111/jth.12085\n10.1182/blood-2013-01-478958\n10.1016/S0049-3848(17)30065-8\n10.1213/ANE.0000000000002530\n10.1378/chest.11-2290\n10.1182/bloodadvances.2018024802\n10.1182/bloodadvances.2019000462\n10.1258/jhsrp.2007.007074\n10.1177/1558689819834753\n10.1007/s00198-019-04913-y\n10.1007/s11606-009-0987-8\n10.1016/j.jclinepi.2019.08.008\n10.1136/bmjopen-2020-046021\n10.1370/afm.1865\n10.1097/XEB.0000000000000052\n10.1111/1475-6773.12117\n10.1007/s11136-016-1423-2\n10.1002/nur.10072\n10.1016/j.jclinepi.2018.05.011\n10.1016/j.jclinepi.2018.01.013\n10.1016/j.jclinepi.2021.11.026\n10.1016/j.thromres.2018.11.020\n10.1016/j.thromres.2015.12.015\n10.3109/01443615.2015.1009878\n10.1038/nrcardio.2015.172\n10.1111/jth.12020\n10.1111/j.1552-6909.2006.00113.x\n10.1016/j.thromres.2015.05.020\n10.1080/08870449908407311\n10.1080/14767058.2018.1512573\n10.1016/j.ejogrb.2012.12.022\n10.1111/jep.12884\n10.7326/M19-1326\n10.1182/bloodadvances.2018024802\n10.1111/j.1538-7836.2011.04553.x\n10.1111/j.1538-7836.2008.03230.x",
    "journal": "BMC pregnancy and childbirth",
    "keywords": [
        "Low-molecular-weight-heparin",
        "Pregnancy",
        "Values and preferences",
        "Venous thromboembolism"
    ],
    "methods": null,
    "publication_date": "2022-10-06",
    "pubmed_id": "36199014\n16287790\n30671924\n25756165\n27799457\n31419948\n23205953\n31949319\n24357725\n28262232\n29099429\n22315262\n30482767\n32150612\n18416914\n30859238\n19387746\n31470075\n33753445\n33782057\n26553895\n20098638\n26196082\n24279835\n27704305\n12652611\n28851437\n31948937\n30002103\n29800687\n29452223\n30775016\n29384082\n34800676\n30500674\n27500301\n25692872\n8466376\n23039905\n17238947\n33472256\n26033397\n30231658\n21262443\n0\n23352620\n22220321\n26286178\n29464873\n29384079\n31569219\n26670769\n30482767\n22118560\n25706216\n19036070\n27145932\n34711446\n29384080\n29384077",
    "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.",
    "title": "Women's values and preferences on low-molecular-weight heparin and pregnancy: a mixed-methods systematic review.",
    "xml": "<Element 'PubmedArticle' at 0x7885032a14e0>"
}