Nigerian Medical Journal

LETTER TO EDITOR
Year
: 2014  |  Volume : 55  |  Issue : 1  |  Page : 86-

The role of low-dose aspirin in the prevention of pre-eclampsia


RE Akhigbe 
 Department of Physiology, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo, Nigeria

Correspondence Address:
R E Akhigbe
Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Oyo
Nigeria




How to cite this article:
Akhigbe R E. The role of low-dose aspirin in the prevention of pre-eclampsia.Niger Med J 2014;55:86-86


How to cite this URL:
Akhigbe R E. The role of low-dose aspirin in the prevention of pre-eclampsia. Niger Med J [serial online] 2014 [cited 2019 Dec 7 ];55:86-86
Available from: http://www.nigeriamedj.com/text.asp?2014/55/1/86/128180


Full Text

Sir,

The role of low-dose aspirin in the prevention of pre-eclampsia has gained attention in recent time. Pre-eclampsia is a multi-systemic disorder characterised by hypertension of at least 140/90 mmHg recorded on two occasions at least 4-6 hours apart in the presence of proteinuria (≥0.3 mg protein in a 24-hour urine sample or ≥1 + using a dipstick) with or without oedema, arising de novo after the 20 th week of gestation in a previously normotensive woman and resolving completely within 42 days post-partum. [1] For many years, researchers have sought to investigate the mechanism of this thrombohemostatic disease and the possible role of low-dose aspirin (LDA), a prostaglandin synthesis inhibitor, in the prevention of the disorder.

Pre-eclampsia has been associated with imbalance between vasodilating and vasoconstricting prostaglandins. This has led to the use of LDA, which inhibits thromboxane production more than prostacyclin production and therefore should protect against vasoconstriction and pathologic blood coagulation in the placenta. [2]

Trivedi in his meta-analysis revealed that LDA has a marginal effect in the prevention of pre-eclampsia in high-risk pregnant women, however, it is ineffective in reducing the risk in the low-risk group. [3] His results are in concordance with some previous studies, however, these contrast with the finding of Bujold et al.,[4] which showed a significant reduction in the development of pre-eclampsia following LDA in moderate to high-risk pregnant women when started at 16 weeks or earlier. This beneficial effect was lost when LDA was given after 16 weeks of gestation.

Conflicting reports makes the usefulness of LDA in preventing pre-eclampsia a controversial issue. However, some questions should be answered. What are the causes of the disparities in the findings reported by different researchers? What are the risks of using LDA?

First, different doses of aspirin were used as LDA. Different doses of LDA used include 50, 60, 75, 100 and 150 mg/day. Also, the onset of treatment has been shown to play a role in the prophylactic use of LDA in preventing pre-eclampsia. Treatments at 16 th and 24 th week of gestation have been documented to have a beneficial effect. [4] The time of treatment has also been shown to play a role. LDA at bedtime could provide greater benefits and pre-eclampsia prevention than when taken in the morning. [5]

Also, none of these studies has reported any significant side effect with the use of LDA. Weighing the benefits and risks, and with the medical maxim in mind - 'primum non nocere', LDA use in the prevention of pre-eclampsia should not be discouraged since there may be moderate benefit of LDA in preventing pre-eclampsia and because the risks of LDA are few.

Further studies comparing the use of LDA using different doses at different time of the day and commencing treatment at different stages of pregnancy would be of great value in postulating a standard regime for the prophylactic use of LDA in preventing pre-eclampsia.

References

1Decherney AH, Nathan L, Goodwin TM, Laufer N. Hypertension in pregnancy. In: Current Diagnosis and Treatment in Obstetrics and Gynecology. 10 th ed. New York: McGraw-Hill Medical Publishing Division; 2007. p. 318-27.
2Caritis S, Sibai B, Hauth J, Lindheimer M, Klebanoff M, Thom E, et al. Low-dose aspirin to prevent preeclampsia in women at high risk. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med 1998;338:701-5.
3Trivedi NA. A meta-analysis of low-dose aspirin for prevention of preeclampsia. J Postgrad Med 2011;57:91-5.
4Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, et al. Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: A meta-analysis. Obstet Gynecol 2010;116:402-14.
5Hermida RC, Ayala DE, Fernández JR, Mojón A, Alonso I, Silva I, et al. Administration time-dependent effects of aspirin in women at differing risk for preeclampsia. Hypertension 1999;34:1016-23.