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Evevident
Original paper
2017NEJMOB/GYN

ASPRE

Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia

RCTPreeclampsia prevention

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Overview

Aspirin started early reduced preterm preeclampsia in screened high-risk pregnancies.

Clinical takeaway

ASPRE supports early low-dose aspirin prophylaxis for pregnant patients at high risk of preeclampsia, now a common prenatal counseling point.

Key result

Preterm preeclampsia occurred in 1.6% with aspirin vs 4.3% with placebo.

Practice impact

High-risk pregnant patients should be considered for aspirin prophylaxis starting in late first trimester.

Evidence

Study design

Randomized, double-blind, placebo-controlled trial.

Enrollment

1,776

Follow-up

Through delivery.

Geography

Multinational

Clinical question

Does aspirin reduce preterm preeclampsia in pregnancies screened as high risk in the first trimester?

Population

  • Singleton pregnancies identified as high risk for preterm preeclampsia by first-trimester screening.

Intervention

Aspirin 150 mg nightly from 11-14 weeks until 36 weeks' gestation.

Comparator

Placebo.

Primary outcome

Delivery with preeclampsia before 37 weeks' gestation.

Early aspirin prophylaxis reduced preterm preeclampsia in high-risk singleton pregnancies.

Odds ratio / 0.38 / CI 95% CI 0.20-0.74 / p=0.004

Key results

  • Preterm preeclampsia: 1.6% with aspirin vs 4.3% with placebo.
  • Benefit was strongest when adherence was high.
  • No significant excess of major adverse neonatal or maternal outcomes was reported.

Harms

  • Bleeding risk must be considered, though major bleeding excess was not the key signal in ASPRE.

Clinical Use

When to cite

  • When counseling high-risk pregnant patients about low-dose aspirin prophylaxis.

Practice impact

  • Reinforced first-trimester aspirin prophylaxis for patients at high risk for preeclampsia.

Applicability

  • Pregnant patients with high preeclampsia risk identified early enough to start aspirin before 16 weeks.

Limitations

  • Used a specific screening algorithm and 150 mg dose, while many guidelines use different criteria and 81 mg dosing.
  • Does not replace BP surveillance or treatment of chronic hypertension.

Common misinterpretations

  • Aspirin prevention is not treatment for established preeclampsia.

Related evidence

CHAP - Same DiseaseMAGPIE - Same Disease

Citation

Rolnik DL, Wright D, Poon LC, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017;377(7):613-622. doi:10.1056/NEJMoa1704559

Treatment with low-dose aspirin in women at high risk for preterm preeclampsia resulted in a lower incidence of this diagnosis than placebo.