Preeclampsia and aspirin

Abstract

Preeclampsia (PE) is a multisystem disorder that is an important cause of maternal and perinatal deaths. Currently, delivery is the only final treatment for PE. This practice is usually accompanied by premature birth, which inevitably increases neonatal morbidities. Aspirin is a non-selective NSAID that irreversibly inhibits cyclooxygenase enzymes involved in converting arachidonic acid to prostaglandins and thromboxane. Aspirin inhibits thromboxane A2 production via platelet aggregation, thereby increasing the prostacyclin/thromboxane A2 ratio and reducing platelet aggregation. Since the first case report of aspirin's potential use during pregnancy was reported in 1978, many studies have attempted to confirm the effect of aspirin on preeclampsia, and the results have been controversial. However, this preventive strategy is generally accepted in clinical practice.As evidence for aspirin's prevention of pre-eclampsia has been accumulating, a recent study investigated the effectiveness of aspirin at high doses of 150 mg, which is higher than before.However, there is an ongoing debate about how much aspirin should be used during pregnancy and when to start aspirin therapy. Guidelines for the use of prophylactic aspirin during pregnancy vary slightly among countries and groups. In this article, we review and summarize the evidence regarding the use of aspirin for PE prevention.

Hydroxychloroquine in obstetrics: potential implications of the prophylactic use of hydroxychloroquine for placental insufficiency during pregnancy

“…Therefore, the high recurrence rate of placental insufficiency places a significant burden on women planning subsequent pregnancies. A history of PE is considered the most important risk factor and predictor of PE development during subsequent pregnancies [ 16 ]. The recurrence rate varies depending on clinical factors; however, approximately 15–50% of women with a history of placental insufficiency may experience recurrence [ 17 , 18 ].…”

Human umbilical cord mesenchymal stem cell derived exosomes (HUCMSC-exos) recovery soluble fms-like tyrosine kinase-1 (sFlt-1)-induced endothelial dysfunction in preeclampsia

“…PE is a unique multisystem disorder that leads to maternal and fetal morbidity and mortality. Therapeutic strategies aimed at reducing blood pressure and improving fetal birth outcomes are being pursued as avenues to prevent PE [ 24 ]. In the current study, we showed that HUCMSC-exos provided therapeutic benefits in animal models of PE by improving birth outcomes and vascular functions.…”

Prevención de la preeclampsia y su relevancia en el contexto latinoamericano: una revisión narrativa

“…El efecto de la aspirina disminuyendo el riesgo de preeclampsia es conocido, pero puede no observarse en pacientes con hipertensión de larga data y está en estrecha relación con el cumplimiento de las indicaciones y dosis 32,[50][51][52] . En la preeclampsia, la invasión trofoblástica subóptima provoca un desequilibrio de factores angiogénicos y antiangiogénicos, lo que finalmente resulta en inflamación generalizada y daño endotelial, aumento de la agregación plaquetaria y eventos trombóticos placentarios 53,54 . En relación con esto, la aspirina inactiva de manera selectiva e irreversible la enzima ciclooxigenasa-1, lo que reduce la producción de prostaglandinas y tromboxano, así como la inflamación y la agregación plaquetaria; como resultado, se presenta como una estrategia útil para prevenir la preeclampsia [53][54][55] .…”

“…En la preeclampsia, la invasión trofoblástica subóptima provoca un desequilibrio de factores angiogénicos y antiangiogénicos, lo que finalmente resulta en inflamación generalizada y daño endotelial, aumento de la agregación plaquetaria y eventos trombóticos placentarios 53,54 . En relación con esto, la aspirina inactiva de manera selectiva e irreversible la enzima ciclooxigenasa-1, lo que reduce la producción de prostaglandinas y tromboxano, así como la inflamación y la agregación plaquetaria; como resultado, se presenta como una estrategia útil para prevenir la preeclampsia [53][54][55] . Las dosis bajas de aspirina no han demostrado mayores beneficios para prevenir la preeclampsia 56,57 , y en consecuencia se recomienda utilizar dosis de al menos 100 mg desde el primer trimestre y considerar un ajuste de dosis en pacientes con gestación múltiple 3,4 .…”