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Hypothesis Pre-eclampsia is associated with: ↓Intravascular Prostacyclin – A vasodilator – And... ↑Production of Thromboxane –That increases platelet stickiness So low dose aspirin may prevent or reduce the severity of this disease
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Aspirin for Pre-eclampsia?
Max Brinsmead MB BS PhDJuly 2015
Resource for this Presentation:
Cochrane Database
“Anti platelet agents for preventing pre –eclampsia and its complications”
A Review published February 2007
And its conclusions confirmed in 2010
Hypothesis Pre-eclampsia is associated
with:
↓Intravascular Prostacyclin– A vasodilator– And...
↑Production of Thromboxane– That increases platelet stickiness
So low dose aspirin may prevent or reduce the severity of this disease
A Meta analysis of 59 trials involving 37,560 women found that
Aspirin will Reduce the risk of pre-eclampsia by
17% (RR 0.83 and CI 0.77 – 0.89) Number needed to treat is 72 But for high risk patients the number
needed to treat is 19 When high risk is defined as:– Previous severe pre-eclampsia– Chronic hypertension– Diabetes– Renal disease– Auto immune disease
Other Outcomes Reduce the risk of preterm
delivery by 8% (RR 0.92 CI 0.88 – 0.97) Reduce the risk of perinatal death
by 14% (RR 0.86 CI 0.76 – 0.98) Reduce the rate of SGA infants by
10% (RR 0.90 CI 0.83 – 0.98) No significant effect on:
– Risk of maternal death– Rate of Caesarean– Induction of Labour– Antenatal admission or Nursery Use
Is it Safe? The rate of abruptio placenta is
increased by 10% but this difference is not significant
(RR 1.10 CI 0.89-1.37) No increased rate of Neonatal
Intracerebral Haemorrhage Or any measure of neonatal bleeding One study (CLASP,1994) followed
children to 18 months of age and found no observable differences
Another study (Italy, 1993) found higher rates of gross and fine motor problems in children of treated mothers at 18 months but this study was unblinded and had other follow problems
Unanswered Questions What is the best dose?
– 75 mg daily is safe– Some evidence that higher doses may be
more effective When should the Aspirin be started?
– This study showed no difference in outcomes when analysed according to commencement before or after 20 weeks gestation
– But many argue that most benefit is likely to occur with commencement at <12 weeks and before trophoblast invasion of spiral arterioles occurs
Are adjuvants likley to be useful? e.g.– Other anti-platelet agents or even Heparin– Ca or Mg– Fish oil – (antioxidants have been ruled out)
Any Questions or Comments?
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