Dose of aspirin to prevent preterm preeclampsia in women with moderate or high-risk factors: A systematic review and meta-analysis

Abstract

Objective To evaluate the effect of aspirin dose on the incidence of all gestational age preeclampsia and preterm preeclampsia. Data sources Electronic databases (Cochrane, PubMed, Scopus, ClinicalTrials.gov and the Web of Science) were searched for articles published between January 1985 and March 2019 with no language restrictions. Methods We followed the PRIMSA guidelines and utilized Covidence software. Articles were screened by 2 independent reviewers, with discrepancies settled by an independent 3rd party. Study selection criteria were randomized trials comparing aspirin for prevention of all gestational age and preterm preeclampsia to placebo or no antiplatelet treatment in women aged 15–55 years with moderate or high-risk factors according to the list of risk factors from American College of Obstetricians and Gynecologists and United States Preventive Services Task Force guidelines. The quality of trials was assessed using the Cochrane risk of bias tool. The data were pooled using a random-effects meta-analysis comparing aspirin at doses of <81, 81, 100, and 150 mg. Pre-specified outcomes were all gestational age and preterm preeclampsia. Results Of 1,609 articles screened, 23 randomized trials, which included 32,370 women, fulfilled the inclusion criteria. In preterm preeclampsia, women assigned at random to 150 mg experienced a significant 62% reduction in risk of preterm preeclampsia (RR = 0.38; 95% CI: 0.20–0.72; P = 0.011). Aspirin doses <150 mg produced no significant reductions. The number needed to treat with 150 mg of aspirin was 39 (95% CI: 23–100). There was a maximum 30% reduction in risk of all gestational age preeclampsia at all aspirin doses. Conclusions In this meta-analysis, based on indirect comparisons, aspirin at a dose greater than the current, recommended 81 mg was associated with the highest reduction in preterm preeclampsia. Our meta-analysis is limited due to the deficiency of homogeneous high evidence data available in the literature to date; however, it may be prudent for clinicians to consider that the optimal aspirin dose may be higher than the current guidelines advise. Future research to compare the efficacy aspirin doses greater than 81 mg is recommended. Study registration PROSPERO, CRD42019127951 (University of York, UK; http://www.crd.york.ac.uk/PROSPERO/).

Expression and clinical significance of lncRNA NORAD in patients with gestational hypertension

“…Pregnant women have negative urine protein, and a small number of patients may have upper abdominal discomfort or thrombocytopenia. And the most common complication of gestational hypertension is the development of preeclampsia, in which pregnant women have hypertension greater than 140/90 mmHg and proteinuria with urine protein ≥ 0.3 g (24 h) [27]. At the present stage, more conservative treatment methods are generally adopted for the treatment of gestational hypertension.…”

The Targeting of Nuclear Factor Kappa B by Drugs Adopted for the Prevention and Treatment of Preeclampsia

“…Numerous randomised controlled clinical trials and big data meta-analyses indicate that early supplementation with low doses of aspirin, i.e., acetylsalicylic acid (ASA), is effective in preventing preeclampsia. However, although aspirin treatment improves the outcome of pregnancy, reducing the risk of preterm preeclampsia by approximately 30–62%, conflicting data exists regarding the optimal dose and time of initiation of ASA intake [ 32 , 33 , 34 ]. In numerous countries, the guidelines prepared by cardiology, gynaecology and obstetrics societies recommend the initiation of aspirin treatment before week 20 (optimum before week 16) of gestation among high- and moderate-risk women ( Table 1 ).…”

Acute Atherosis Lesions at the Fetal-Maternal Border: Current Knowledge and Implications for Maternal Cardiovascular Health

“…Outside of pregnancy, aspirin is widely used for primary and secondary prevention of atherosclerotic CVD ( 210 ). Daily low-dose aspirin started during the first trimester has shown a substantially reduced risk of preeclampsia in women at high risk ( 211 – 213 ). Whether this effect is related to a reduced tendency of blood clot formation, and how this may relate to acute atherosis, remains to be investigated.…”