Improving Utilization of Aspirin for Prevention of Preeclampsia in a High-Risk Urban Cohort: A Prospective Cohort Study

Boelig, Rupsa C.; Wanees, Mariam; Berghella, Vincenzo; Roman, Amanda

doi:10.1055/s-0040-1718580

Cited by 9 publications

(14 citation statements)

References 18 publications

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“…17,18 However, similar to our study, Boelig et al showed that the implementation of a clinical checklist improved provider LDA recommendation to 95%. 18 Our study has some limitations. We do not know how the counseling style differed among physicians and whether patients responded differently to different counseling styles.…”

Section: Strength and Weaknesssupporting

confidence: 87%

Feasibility of Universal Screening for Preeclampsia Risk and Aspirin Recommendation in the Ultrasound Unit

Pimentel,

Larrea,

Renaud

et al. 2023

Am J Perinatol

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Objective To evaluate the feasibility and impact of using the first-trimester ultrasound visit to identify and counsel women at increased risk of preeclampsia about the benefits of low-dose aspirin (LDA) for preventing preeclampsia. We also assessed patient-reported utilization of LDA, perceived risk for preeclampsia, and clinical outcomes. Study Design Women presenting for routine first-trimester nuchal-translucency (NT) ultrasounds were screened for clinical preeclampsia risks using a self-administered risk assessment. Women at moderate or high risk for preeclampsia were counseled to take LDA, if not already taking it. LDA utilization and perceived risk for preeclampsia were assessed during the second-trimester ultrasound. Factors associated with LDA utilization were analyzed. Pregnancy outcomes were compared between those who used LDA and those who did not. Results Slightly more than 20% of patients (765/3,669) screened at increased risk for developing preeclampsia. Of those, 67.8% (519/765) had not received LDA recommendations from their referring obstetrician and 97 had not been taking LDA despite being advised to do so. Combined, 94.6% (583/616) of these patients eligible to start LDA prophylaxis received the indicated counseling during the ultrasound visit. A total of 61.4% (358/583) of women completed the follow-up form and of those 77.9% (279/358) reported taking LDA. Screening at increased risk for preeclampsia and perception of increased risk were positively associated with LDA utilization, whereas concerns for LDA safety were negatively associated with use. African American/Black patients and Medicaid recipients were less likely to use LDA. Pregnancy outcomes were similar between those who used LDA and those who did not. Conclusion Assessing preeclampsia risk and counseling patients about LDA at the time of the NT ultrasound are feasible in the ultrasound unit and led to good LDA utilization among women at increased risk for preeclampsia. This intervention may standardize patient care and help close the disparity in maternal health. Key Points

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Section: Strength and Weaknesssupporting

confidence: 87%

Feasibility of Universal Screening for Preeclampsia Risk and Aspirin Recommendation in the Ultrasound Unit

Pimentel,

Larrea,

Renaud

et al. 2023

Am J Perinatol

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“…A second study, by Boelig and colleagues, assessed provider adherence to aspirin recommendations before and after implementation of a preeclampsia risk assessment tool designed to help identify at-risk women. (Boelig et al, 2020) The study analyzed only prescribing rates for women with one or more "high" risk factor, and did not assess rates for women with multiple "moderate" risk factors. They found that prior to implementation of the screening tool 74% of eligible women were recommended aspirin prophylaxis, compared to 95% following this intervention.…”

Section: Conclusion For Practicementioning

confidence: 99%

Relationship between risk factor profile and prescription of low-dose aspirin for preeclampsia prevention

Phelps

Holmgren

2022

Arch Gynecol Obstet

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The purpose of this study was to assess obstetrician-gynecologist utilization of low-dose aspirin for women at increased risk for hypertensive disorders of pregnancy. Further, the study evaluated prescribing practices in relation to speci c risk factor pro les in order to identify which women are at highest risk of not receiving recommended therapy. Methods:This was a retrospective cohort study reviewed and approved by the local Institutional Review Board. Electronic health records were reviewed to identify risk factors for preeclampsia. Women were eligible for aspirin prophylaxis if they had at least one "high" risk factor or multiple "moderate" risk factors.Associations of interest were addressed using Pearson Chi-squared tests and multinomial logistic regression.Results: 970 patients were included and 301 women (31%) met criteria for low-dose aspirin prophylaxis; of these, 92 (31%) were given this recommendation. Women eligible for prophylaxis by presence of multiple "moderate" risk factors alone were least likely (0-6%) to have a low-dose aspirin prescription. Conclusions for Practice:Low-dose aspirin is an underutilized tool for preventing preeclampsia. Women with a combination of "moderate" risk factors are most likely to not receive indicated aspirin prophylaxis. Efforts should be made to encourage broader uptake of the recommendations for aspirin prophylaxis among obstetriciangynecologists. Signi canceWhat is already known on this subject? Low-dose aspirin has been shown to reduce preeclampsia risk in pregnant women. This preventative measure has been recommended by prominent organizations including the American College of Obstetricians and Gynecologists and the United States Preventive Services Task Force. Yet despite widespread support of this recommendation, uptake is not universal among obstetric care providers. What this study adds?This study identi es those who are most likely to experience a missed opportunity for aspirin prophylaxis, thus providing a suggestion for where provider education or other efforts to increase adherence to this guideline may be most impactful. DeclarationsFunding: There was no nancial support obtained for the conduct of this research or preparation of this article for publication.Con icts of interest: The authors report no con icts of interest.Ethics approval: The project was reviewed and approved by the local Institutional Review Board (IRB) prior to commencement of the project.Consents: Waivers of informed consent or consent for publication were obtained from the IRB due to the retrospective nature of this chart review and since no patient-identifying information will be published.

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“…Our findings suggest a potentially actionable, common (~10%–15% of general population, 23 30% of Black individuals), genetic variant that may contribute to disparate response to aspirin therapy 20 and risk of preterm birth. Prior studies at our institution have demonstrated a persistently high (~30%) rate of preeclampsia in high‐risk populations despite aspirin therapy 44,45 20 .…”

Section: Results In the Context Of What Is Knownmentioning

confidence: 91%

“…Prior studies at our institution have demonstrated a persistently high (~30%) rate of preeclampsia in high-risk populations despite aspirin therapy. 44,45 Studies on PAR4Thr120 variant in nonpregnant adults identify a reduced response to antiplatelet therapies. 20 The potential pharmacogenomics implications of the optimal antiplatelet therapy formulation and dose to reduce that risk in individuals homozygous for PAR4Thr120 needs to be studied prospectively.…”

Section: Clinical and Research Implicationsmentioning

confidence: 99%

Platelet protease activated receptor 4 (PAR 4) receptor genotype is associated with an increased risk of preterm birth

Boelig

Cahanap

et al. 2022

Journal of Thrombosis and Haemostasis

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Background: Platelet protease activated receptor-4 (PAR4) Thr120 is a common genetic variant associated with increased platelet activity. Increased platelet activity is implicated in the pathogenesis of preeclampsia and preterm birth.Objective: Compare the rate of preeclampsia and preterm birth in pregnant individuals homozygous for PAR4 Thr120 variant vs not.Study Design: This is a prospective cohort study of patients who delivered November 2020-July 2021. Maternal blood collected on admission for PAR4 genotyping. The primary outcome was the rate of preeclampsia/gestational hypertension in those with Thr/Thr genotype compared with Ala/Thr or Ala/Ala. Secondary outcomes included rates of preterm birth and placental pathology.Results: Three hundred and twenty singletons were included and 52 (16.3%) were PAR4 Thr/Thr. Those PAR4 Thr/Thr were more likely to be Black (67.3% vs 29.5%, p < .001), younger (28 ± 6 vs 31 ± 6, p = .004), and have higher body mass index (35.2 ± 6.8 vs 33.1 ± 7.4, p = .047). There was no difference in preeclampsia/gestational hypertension (19.2% vs 22.8%, p = .705). Those Thr/Thr had a significantly higher rate of preterm birth (15.4% vs 3.7%, adjusted odds ratio [aOR] 4. 04 [1.47-11.10],

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Improving Utilization of Aspirin for Prevention of Preeclampsia in a High-Risk Urban Cohort: A Prospective Cohort Study

Cited by 9 publications

References 18 publications

Feasibility of Universal Screening for Preeclampsia Risk and Aspirin Recommendation in the Ultrasound Unit

Feasibility of Universal Screening for Preeclampsia Risk and Aspirin Recommendation in the Ultrasound Unit

Relationship between risk factor profile and prescription of low-dose aspirin for preeclampsia prevention

Platelet protease activated receptor 4 (PAR 4) receptor genotype is associated with an increased risk of preterm birth

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