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Lookup NU author(s): Raya Vinogradov, Clare Boag, David McGeeney, Professor Vijay KunadianORCiD, Professor Steve RobsonORCiD
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© 2020 Elsevier B.V.Objectives: Low dose aspirin (LDA) is recommended for women at increased risk of preeclampsia (PE), however it is not always effective. The study sought to determine the prevalence of non-response to LDA and to ascertain the effect of increasing aspirin dose in non-responders. Study design: Single centre, cohort study of 166 women at increased risk of PE was conducted in a large maternity unit in the UK between 2013 and 2016. All women were prescribed 75 mg of aspirin and invited to attend study visits at 18–24 weeks’ and 32–36 weeks’ gestation. Non-response was defined as a serum thromboxane B2 (TXB2) ≤10 ng/mL. Aspirin dose was increased to 150 mg if a bedside VerifyNow test suggested non-response (test value ≥ 550 arachidonic acid reactive units [ARU]) at 18–24 weeks. Adherence was assessed by self-report. Results: Based on serum TXB2, response rates were 85.3 % at 18–24 weeks and 79.3 % at 32–36 weeks’ gestation. Compared to serum TXB2, the VerifyNow test demonstrated moderate test performance (AUC 0.79 95 % CI 0.71−0.88, p < 0.0001) to detect non-response. High prevalence of non-adherence (6/10) was evident in persistent non-response group. Dose change from 75 to 150 mg of aspirin in adherent participants improved response (VerifyNow: 598 [95 % CI 550–665] ARU at 18–24 weeks on 75 mg aspirin, 509 [95 % CI 350–667] at 32–36 weeks on 150 mg of aspirin, [p < 0.0001]). Conclusions: Non-response to LDA is common in pregnancy but appears to be largely attributable to non-adherence. Dose change could be useful to improve response to LDA in this cohort.
Author(s): Vinogradov R, Boag C, Murphy P, McGeeney D, Kunadian V, Robson SC
Publication type: Article
Publication status: Published
Journal: European Journal of Obstetrics and Gynecology and Reproductive Biology
Year: 2020
Volume: 254
Pages: 292-297
Online publication date: 23/09/2020
Acceptance date: 21/09/2020
ISSN (print): 0301-2115
ISSN (electronic): 1872-7654
Publisher: Elsevier Ireland Ltd
URL: https://doi.org/10.1016/j.ejogrb.2020.09.036
DOI: 10.1016/j.ejogrb.2020.09.036
PubMed id: 33039837
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