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#Grand Rounds

Is There a Link Between Aspirin Use in Pregnancy and Increased Risk of Bleeding Complications?

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BACKGROUND AND PURPOSE:

  • Hastie et al. (AJOG, 2020) investigated whether aspirin use during pregnancy is associated with an increased risk of bleeding complications

METHODS:

  • Register-based cohort study
  • Data sources
    • Swedish Pregnancy Register
    • Combines prospectively collected data (from the first prenatal visit to postpartum follow-up)
  • Participants
    • Delivery between January 2013 to July 2017
  • Exposure
    • Self-reported use of aspirin at any time during pregnancy
  • Study design
    • The authors used logistic regression to assess the risk of hemorrhage
      • Antepartum | Intrapartum | Postpartum
    • Odds ratio (OR) was calculated and adjusted for confounding
  • Primary outcome
    • Bleeding complications recorded in prenatal or delivery records

RESULTS:

  • A total of 313,624 women gave birth during the study period
    • Aspirin use during pregnancy: 1.3%

Antepartum

  • Aspirin use was not associated with bleeding complications during the antepartum period
    • adjusted OR: 1.22 (95% CI, 0.97 to 1.54)

Intrapartum

  • Aspirin was associated with a higher incidence of intrapartum hemorrhage (cases of placenta previa and abruption were excluded from analyses)
    • Aspirin users: 2.9%
    • Non-users: 1.5%
    • aOR 1.63 (95% CI, 1.30 to 2.05)

Postpartum

  • PPH
    • Aspirin users: 10.2%
    • Non-users: 7.8%
    • aOR 1.23 (95% CI 1.08 to 1.39)
  • Aspirin was associated with increased risk for postpartum hematoma
    • Aspirin users: 0.4%
    • Non-users: 0.1%
    • aOR 2.21 (95% CI, 1.13 to 4.34)

Neonatal

  • The risk of a neonatal intracranial hemorrhage was also increased with aspirin use (adjusted for gestational age at delivery and mode of delivery)
    • Aspirin users: 0.07%
    • Non-users: 0.01%
    • aOR 9.66 (95% CI, 1.88 to 49.48)

Note: Higher incidence of bleeding associated with aspirin was found in women with vaginal birth and not caesarean

CONCLUSION:

  • In women who delivery vaginally, aspirin use during pregnancy was associated with an increased risk for intra and postpartum hemorrhage as well as neonatal intracranial bleeding
  • Authors recognize limitation that aspirin dose not recorded
    • However, Swedish guidelines recommend 75 mg of aspirin daily after 12 weeks for preterm preeclampsia prevention
    • Therefore, the assumption is that most aspirin users in this cohort would be taking a 75 mg per day dose
  • The authors conclude that

When offering aspirin during pregnancy these risks need to be weighed against the potential benefits

Learn More – Primary Sources:

Aspirin use during pregnancy and the risk of bleeding complications: A Swedish population-based cohort study.


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Related ObG Topics:

ASPRE Trial: A Combined Risk Algorithm and Use of Aspirin to Prevent Preterm Preeclampsia
ASPIRIN RCT Results: Low-Dose Aspirin in Early Pregnancy and Impact on Preterm Delivery and Perinatal Mortality

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