Discontinuing aspirin at 24 to 28 weeks gestation feasible for preeclampsia prevention while reducing bleeding risk: JAMA

For this purpose, the researchers conducted a randomized, open-label, multicenter, phase 3, noninferiority trial in 9 maternity hospitals across Spain. They included 968 pregnant women at high preeclampsia risk during the first-trimester screening and an sFlt-1:PlGF ratio of 38 or less at gestation weeks 24 to 28 between 2019 and 2021. Of 968, 936 were analyzed; 473 were in the intervention, and 463 were in control. All participants were followed-up until delivery.

Enrolled patients were randomly allocated in a 1:1 ratio to the intervention group (aspirin discontinuation) or control group (aspirin continuation) until 36 weeks of gestation.

Noninferiority was met if the higher difference in preterm preeclampsia incidences between groups was less than 1.9%.

The study led to the following findings:

• Among the 936 participants, the mean age was 32.4 years; 3.4% were Black, and 93% were White.
• The incidence of preterm preeclampsia was 1.48% in the intervention group and 1.73% in the control group (absolute difference, −0.25%), indicating noninferiority.

To conclude, aspirin discontinuation at gestation weeks 24 to 28 was noninferior to aspirin continuation for preterm preeclampsia prevention in pregnant women at high preeclampsia risk and a normal sFlt-1:PlGF ratio.

Reference:

Mendoza M, Bonacina E, Garcia-Manau P, et al. Aspirin Discontinuation at 24 to 28 Weeks’ Gestation in Pregnancies at High Risk of Preterm Preeclampsia: A Randomized Clinical Trial. JAMA. 2023;329(7):542–550. doi:10.1001/jama.2023.0691