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No aspirin = aspirin after 24 weeks’ gestation in some pregnancies at high risk for preeclampsia
Clinical Question
Is the discontinuation of aspirin beyond 24 to 28 weeks’ gestation noninferior to continuation among a subgroup at high risk for preeclampsia?
Bottom line
For pregnant individuals at high risk for preterm preeclampsia who were treated with aspirin starting late in the first trimester and with normal biomarker assessment for placental ischemia at 24 to 28 weeks’ gestation, the incidence of preterm preeclampsia did not differ if aspirin was stopped or continued. As expected, there were fewer bleeding complications in the discontinuation group. 1b
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Government
Setting: Outpatient (specialty)
Synopsis
Among pregnant individuals at increased risk for preeclampsia, aspirin has been shown to reduce the risk of preterm preeclampsia (onset before 37 weeks’ gestation) if started no later than 16 weeks’ gestation. However, aspirin is also associated with an increased risk of peripartum hemorrhage. These investigators from Spain hypothesized that the beneficial effect of aspirin is related to placental development, which is complete by 20 weeks’ gestation. They conducted a randomized controlled trial to compare the incidence of preterm preeclampsia with discontinuation of 150 mg daily aspirin versus continuation among high-risk pregnant individuals (N = 958) screened and treated beginning at 11 to 13 weeks’ gestation and with normal biomarker ratio for assessment of placental ischemia at 24 to 28 weeks' gestation. The authors used the ratio of soluble fms-like tyrosine kinase-1 to placental growth factor (sFlt:PlGF) with a cut-off of less than 38 to indicate normal. They found that delivery due to preeclampsia did not differ between groups (7/473 [1.48%] vs 8/463 [1.73%]; NS). At least one bleeding complication occurred in 38 of 473 (8.0%) participants in the discontinuation group and 49 of 463 (12.7%) in the continuation group (absolute difference 4.7%; 95% CI 0.8% - 8.6%; number needed to treat = 21; 12 - 126).
Reviewer
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo
Toledo, OH
Comments
Impact assessment
Very good
Aspirin use questionable to prevent pre-eclampsia
Good information
asa preeclamsia
asa consideration