RCT Results: Can Aspirin for Preterm Preeclampsia Be Discontinued at 24 to 28 Weeks?
BACKGROUND AND PURPOSE:
Aspirin reduces the risk of preeclampsia in those at high risk, but it also may increase the risk of peripartum bleeding
A normal soluble fms-like tyrosine kinase–1 to placental growth factor (sFlt-1:PlGF) ratio between 24 and 28 weeks, even in high-risk individuals, was able to exclude early-onset preeclampsia 100% of the time
Mendoza et al. (JAMA, 2023) assessed whether aspirin discontinuation in pregnant individuals with normal sFlt-1:PlGF ratio between 24 and 28 weeks of gestation was noninferior to aspirin continuation to prevent preterm preeclampsia
There was no difference in the incidence of preterm preeclampsia between the groups, indicating noninferiority
Absolute difference −0.25% (95% CI, −1.86 to 1.36)
Stopping aspirin in patients at high risk of preterm preeclampsia who had normal sFlt-1:PlGF ratios at 24 to 28 weeks was noninferior to aspirin continuation
The authors state
Earlier discontinuation could ultimately reduce the risk of bleeding complications and pregnancy complications at term
It could also reduce maternal anxiety, treatment costs, number of visits, ultrasound scans, and iatrogenic interventions in a cohort of healthy pregnant individuals in which more than 95% of cases are actually false-positives and, therefore, are taking a drug unnecessarily
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