Strategies for Prescribing Aspirin to Prevent Preeclampsia

Abstract

To evaluate the cost effectiveness of various preeclampsia screening and aspirin prophylaxis strategies, including a strategy based on biomarker and ultrasound measures. METHODS:We designed a decision analysis to compare preeclampsia-related costs and effects of four strategies for aspirin use in pregnancy initiated before 16 weeks of gestation to prevent preeclampsia. The four strategies were: 1) no aspirin use, 2) biomarker and ultrasound measure-predicated use, 3) use based on the U.S. Preventive Services Task Force guidelines, and 4) universal aspirin use. Our outcomes were preeclampsia-related costs and number of cases per 100,000 pregnant women. Using a threshold of $90,843 per case of preeclampsia, one-way, two-way, and Monte-Carlo sensitivity analyses incorporating varying probabilities of risk reduction due to aspirin use, aspirin-related side effects, and costs were performed to identify ranges at which costs and risks of aspirin-related complications shifted the preferred strategy.

Pre-eclampsia: Universal Screening or Universal Prevention for Low and Middle-Income Settings?

“…14 Mallampati et al studied the outcomes related to the universal use of Aspirin, without clinical or laboratory screening. 15 The authors demonstrated a significant reduction in the incidence of PE, mainly preterm PE, from 311 to 148 cases per 1,000 pregnancies. There was also a significant reduction in costs when the universal prescription was compared with the screening by biomarkers and ultrasound ( US$192.16 per patient).…”

Preeclampsia: Universal Screening or Universal Prevention for Low and Middle-Income Settings?

“…As appealing as the suggestion to give aspirin to all pregnant women given its relative safety and low cost may be, a strategy of universal aspirin use has not been properly assessed in adequately-powered prospective studies. 10 Pregnant women are naturally resistant to medication use in the absence of convincing medical indication, and such an approach would likely be associated with low adherence to treatment. 10 The strong effect of aspirin in the prevention of preeclampsia in high-risk populations 11 may not be observed when the treatment is recommended to the entire obstetric population, and side effects will inevitably become more frequent if millions of women are treated.…”

“…10 Pregnant women are naturally resistant to medication use in the absence of convincing medical indication, and such an approach would likely be associated with low adherence to treatment. 10 The strong effect of aspirin in the prevention of preeclampsia in high-risk populations 11 may not be observed when the treatment is recommended to the entire obstetric population, and side effects will inevitably become more frequent if millions of women are treated. Indeed, data from a previous study on universal aspirin prophylaxis demonstrated no clear treatment benefit, 12,13 increased risk of postpartum hemorrhage, 14 and other hemorrhagic events, 12 as well as low adherence to treatment.…”

Analysis of the effectiveness of aspirin for the prevention of preeclampsia and alternative methods of prevention

“…Эффективность аспирина Показания к применению аспирина во время беременности являются предметом дискуссий, и в последнее время наблюдается тенденция к увеличению срока назначения и чрезмерному использованию аспирина во время беременности. Аспирин эффективен во вторичной профилактике преэклампсии в основном у пациентов с преэклампсией в анамнезе [11,32,33,34]. Влияние аспирина на агрегацию тромбоцитов и на баланс TXA2/PGI2 зависит от дозы.…”