Antiplatelet agents for preventing pre-eclampsia and its complications
Open accessAbstract
BACKGROUND: Pre-eclampsia is associated with deficient intravascular production of prostacyclin, a vasodilator, and excessive production of thromboxane, a vasoconstrictor and stimulant of platelet aggregation. These observations led to the hypotheses that antiplatelet agents, low-dose aspirin in particular, might prevent or delay development of pre-eclampsia. OBJECTIVES: To assess the effectiveness and safety of antiplatelet agents for women at risk of developing pre-eclampsia. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2006), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2005, Issue 1), EMBASE (1994 to November 2005) and handsearched congress proceedings of the International and European Societies for the Study of Hypertension in Pregnancy. SELECTION CRITERIA: All randomised trials comparing antiplatelet agents with either placebo or no antiplatelet agent were included. Quasi-random studies were excluded. Participants were pregnant women at risk of developing pre-eclampsia. Interventions were any comparisons of an antiplatelet agent (such as low-dose aspirin or dipyridamole) with either placebo or no antiplatelet. DATA COLLECTION AND ANALYSIS: Two authors assessed trials for inclusion and extracted data independently. MAIN RESULTS: Fifty-nine trials (37,560 women) are included. There is a 17% reduction in the risk of pre-eclampsia associated with the use of antiplatelet agents ((46 trials, 32,891 women, relative risk (RR) 0.83, 95% confidence interval (CI) 0.77 to 0.89), number needed to treat (NNT) 72 (52, 119)). Although there is no statistical difference in RR based on maternal risk, there is a significant increase in the absolute risk reduction of pre-eclampsia for high risk (risk difference (RD) -5.2% (-7.5, -2.9), NNT 19 (13, 34)) compared with moderate risk women (RD -0.84 (-1.37, -0.3), NNT 119 (73, 333)). Antiplatelets were associated with an 8% reduction in the relative risk of preterm birth (29 trials, 31,151 women, RR 0.92, 95% CI 0.88 to 0.97); NNT 72 (52, 119)), a 14% reduction in fetal or neonatal deaths (40 trials, 33,098 women, RR 0.86, 95% CI 0.76 to 0.98); NNT 243 (131, 1,666) and a 10% reduction in small-for-gestational age babies (36 trials, 23,638 women, RR 0.90, 95% CI0.83 to 0.98). There were no statistically significant differences between treatment and control groups for any other outcomes. AUTHORS' CONCLUSIONS: Antiplatelet agents, largely low-dose aspirin, have moderate benefits when used for prevention of pre-eclampsia and its consequences. Further information is required to assess which women are most likely to benefit, when treatment is best started, and at what dose.
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There are no adverse fetal outcomes reported in the meta-analysis of RCTs of low dose aspirin for the prevention of pre-eclampsia in pregnancy.
“There are no adverse fetal outcomes reported in the metaanalysis of RCTs of low dose aspirin for the prevention of pre-eclampsia in pregnancy.169”
From Recurrent MiscarriageGreen‐top Guideline No. 17 (2023) · cites this paper as [169]
The Authors’ conclusions (in the Background passage; page unavailable) report fewer fetal or neonatal deaths and fewer small-for-gestational-age babies with low-dose aspirin. The review also reports no clear increase in neonatal bleeding, but it does report and assess adverse fetal outcomes rather than finding that none occurred. The claim is supported if it means no increased fetal harm was identified, but its unqualified wording overstates the findings. (LLM, conf=0.84)
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- Authors
- Duley, L., Henderson-Smart, D. J., Meher, S., & King, J. F.
- Affiliations
- University of Leeds (GB)
- The University of Sydney (AU)
- University of Liverpool (GB)
- Royal Women's Hospital (AU)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2007-04-18
- Volume
- 2019
- Issue
- 10
- Pages
- CD004659-CD004659
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6820858
- OpenAlex
- W1902505065
- Cited by
- 1,016
- References
- 1
- Citations by year
- 2026: 9 · 2025: 39 · 2024: 63 · 2023: 79 · 2022: 78 · 2021: 61 · 2020: 63 · 2019: 47 · 2018: 40 · 2017: 50 · 2016: 71 · 2015: 47 · 2014: 65 · 2013: 43 · 2012: 45
- FWCI
- 7.91
- Type
- journal article
- Language
- en
- Update notices
- new_version (2019-10-30)
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Eicosanoids and Hypertension Pharmacology
- Keywords
- preeclampsia, antiplatelet agents, low-dose aspirin, dipyridamole, preterm birth, preeclampsia prevention, thromboxane, prostacyclin, platelet aggregation, maternal risk stratification, adverse effects, pregnancy complications, hypertension in pregnancy, placental insufficiency, fetal growth restriction, neonatal outcomes, maternal outcomes, cost-effectiveness
- MeSH terms
- Aspirin, Female, Fetal Death, Humans, Obstetric Labor, Premature, Platelet Aggregation Inhibitors, Pre-Eclampsia, Pregnancy, Randomized Controlled Trials as Topic
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