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

Hastie, Roxanne; Tong, Stephen; Wikström, Anna‐Karin; Sandström, Anna; Hesselman, Susanne; Bergman, Lina

doi:10.1016/j.ajog.2020.07.023

Cited by 107 publications

(93 citation statements)

References 35 publications

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“…However, a recent registerbased cohort study including 4088 women taking LDA during pregnancy found that compared with women without LDA intake, there had been a higher incidence of intrapartum bleeding, postpartum hemorrhage, and postpartum hematoma, especially in vaginal deliveries. 70 Information regarding definition and type of hemorrhage in the studies of the present meta-analysis was insufficient, and therefore, this information should also be taken cautiously. In contrast, no difference in the occurrence of PA was found between groups; however, pathologic confirmation was not obtained in any of these studies.…”

Section: Systematic Reviewmentioning

confidence: 91%

Low-molecular-weight heparin for prevention of preeclampsia and other placenta-mediated complications: a systematic review and meta-analysis

Cruz‐Lemini

Vázquez

Ullmo

et al. 2022

American Journal of Obstetrics and Gynecology

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BACKGROUND: Evidence on the impact of low-molecular-weight heparin, alone or in combination with low-dose aspirin, for the prevention for preeclampsia in high-risk patients is conflicting. OBJECTIVE: We conducted a meta-analysis of studies published to assess the effectiveness of low-molecular-weight heparin for the prevention of preeclampsia and other placenta-related complications in high-risk women. DATA SOURCES: A systematic search was performed to identify relevant studies, using the databases PubMed and Cochrane Central Register of Controlled Trials, without publication time restrictions. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials comparing treatment with lowmolecular-weight heparin or unfractionated heparin (with or without low-dose aspirin), in highrisk women, defined as either history of preeclampsia, intrauterine growth restriction, fetal demise, or miscarriage or being at high risk after first-trimester screening of preeclampsia. STUDY APPRAISAL AND SYNTHESIS METHODS: The systematic review was conducted according to the Cochrane Handbook guidelines. The primary outcome was the development of preeclampsia. We performed prespecified subgroup analyses according to combination with low-dose aspirin, low-molecular-weight heparin type, gestational age when treatment was started, and study population (patients with thrombophilia, at high risk of preeclampsia or miscarriage). Secondary outcomes included small for gestational age, perinatal death, miscarriage, and placental abruption. Pooled odds ratios with 95% confidence intervals were calculated using a random-effects model. Quality of evidence was assessed using the grading of recommendations assessment, development, and evaluation methodology. RESULTS: A total of 15 studies (2795 participants) were included. In high-risk women, treatment with low-molecular-weight heparin was associated with a reduction in the development of preeclampsia (odds ratio, 0.62; 95% confidence interval, 0.43e0.90; P¼.010); small for gestational age (odds ratio, 0.61; 95% confidence interval, 0.44e0.85; P¼.003), and perinatal death (odds ratio, 0.49; 95% confidence interval, 0.25e0.94; P¼.030). This reduction was stronger if low-molecular-weight heparin was started before 16 weeks' gestation (13 studies, 2474 participants) for preeclampsia (odds ratio, 0.55; 95% confidence interval, 0.39e0.76; P¼.0004). When only studies including low-dose aspirin as an intervention were analyzed (6 randomized controlled trials, 920 participants), a significant reduction was observed in those with combined treatment (low-molecularweight heparin plus low-dose aspirin) compared with low-dose aspirin alone (odds ratio, 0.62; 95% confidence interval, 0.41e0.95; P¼.030). Overall, adverse events were neither serious nor significantly different. Quality of evidence ranged from very low to moderate, mostly because of the lack of blinding, imprecision, and inconsistency. CONCLUSION: Low-molecular-weight heparin use was associated with a significant reduction in the risk of preeclampsia and ot...

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Section: Systematic Reviewmentioning

confidence: 91%

Low-molecular-weight heparin for prevention of preeclampsia and other placenta-mediated complications: a systematic review and meta-analysis

Cruz‐Lemini

Vázquez

Ullmo

et al. 2022

American Journal of Obstetrics and Gynecology

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“…Although there is no specific evidence that aspirin decreases the risk of pre‐eclampsia in women with SCD, in view of their increased risk we recommend that women with SCD and no contraindications should be offered aspirin prophylaxis from 12 weeks 15 . Recent evidence suggests that aspirin may increase the risk of postpartum haemorrhage 39 . so should be stopped at 36 weeks.…”

Section: Antenatal Carementioning

confidence: 99%

Management of sickle cell disease in pregnancy. A British Society for Haematology Guideline

et al. 2021

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This guideline was compiled according to the British Society of Haematology (BSH) process at https://b-s-h.org.uk/guide lines/proposing-and-writing-a-new-bsh-guideline/. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.grade workinggroup.org Literature review detailsThis BSH guideline was developed and updated from a previous Royal College of Obstetricians and Gynaecologists (RCOG) Green-top guideline 1 in accordance with the standard method of producing BSH guidelines. Medline, Embase, the Cochrane Database of Systematic Reviews, the Cochrane Control Register of Controlled Trials (CONTROL), the Database of Abstracts of Reviews and Effects (DARE), the ACP Journal Club and the Ovid database were searched for relevant randomised controlled trials, systematic reviews and meta-analyses between 2000 and August 2018. In all, 218 papers were identified. Search terms included: 'sickle cell', 'hydroxycarbamide', 'antenatal', 'pregnancy', 'intrapartum', 'penicillin prophylaxis', 'ACE inhibitor', 'transfusion', 'ultrasound', 'Doppler', 'echocardiogram', 'anti-coagulation', 'prophylaxis', 'sickle cell and risk factors', 'preconceptual' and 'sickle cell crisis' and included all relevant Medical Subject Headings (MeSH) terms and subheadings. The search was limited to humans and the English language. The National Library for Health and the National Guidelines Clearing House were also searched for relevant guidelines. Review of the manuscriptReview of the manuscript was performed by the BSH Guidelines Committee, General Haematology Task Force, the BSH Guidelines Committee and the members of the sounding board of BSH. It was also placed on the members' section of the BSH website for comment. It has also been reviewed by the Royal College of Obstetricians and Gynaecologists, Sickle Cell Society and BSH Obstetric Haematology Special Interest Group; these organisations do not necessarily approve or endorse the contents.

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“…The use of low-dose aspirin in women who are predicted to be at high risk of early-onset preeclampsia 21 where large numbers of women need to be treated to prevent 1 case of preeclampsia 22 is defended by the low-risk profile of low-dose aspirin, although recently aspirin use in pregnancy has been associated with increased postpartum bleeding and hematoma. 45 Novel therapeutic approaches currently being investigated include targeting the complement system, 46 proangiogenesis, 47 and the use of pravastatin, metformin, proton-pump inhibitors, and micronutrients. 48 These trials may suffer the same consequences as previous ones related to the heterogeneity of preeclampsia.…”

Section: Therapeutic Approachesmentioning

confidence: 99%

The prediction of preeclampsia: the way forward

Myatt

2022

American Journal of Obstetrics and Gynecology

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

Cited by 107 publications

References 35 publications

Low-molecular-weight heparin for prevention of preeclampsia and other placenta-mediated complications: a systematic review and meta-analysis

Low-molecular-weight heparin for prevention of preeclampsia and other placenta-mediated complications: a systematic review and meta-analysis

Management of sickle cell disease in pregnancy. A British Society for Haematology Guideline

The prediction of preeclampsia: the way forward

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