RSS-Feed abonnieren
DOI: 10.1055/s-0037-1615057
Titration of Antiplatelet Treatment in Pregnant Women at Risk of Preeclampsia
Publikationsverlauf
Received
14. August 1997
Accepted after resubmission
28. November 1997
Publikationsdatum:
07. Dezember 2017 (online)
Summary
We recruited 111 patients who were considered to be at significantly increased risk of preeclampsia on the basis of previous obstetric history or preexisting medical disorders. All patients were treated with low dose aspirin (75 mg/day) from the first occasion the patient attended the antenatal clinic, regardless of gestational age. If the maternal mean platelet volume (MPV) increased significantly (by >0.8 fl) from the baseline, antiplatelet treatment was increased. Five pregnancies were lost during the second trimester and 106 of the treated patients had live infants. The incidence of neonatal death (3/106 infants) was much lower than in the previous pregnancies in these patients (32/134 infants). Patients who were treated from the first trimester of pregnancy (group A, 89 patients) did substantially better than those treated from the second trimester (group B, 17 patients) as assessed by the incidence of pre-eclampsia or intrauterine growth restriction (IUGR), gestational age and birthweight at delivery. These data suggest that longitudinal monitoring of the MPV may identify the women who could benefit from increased antiplatelet treatment, and that antiplatelet treatment may be more effective when initiated in the first trimester rather than later in pregnancy.
-
References
- 1 Lindheimer MD, Katz AI. Pathophysiology of preeclampsia. Ann Rev Med. 1981; 32: 273-89.
- 2 Roberts JM, Taylor RN, Musci TJ, Rodgers GM, Hubel CA, McLaughlin MK. Preeclampsia: an endothelial cell disorder. Am J Obstet Gynecol 1989; 161: 1200-4.
- 3 Ahmed Y, Sullivan MHF, Elder MG. Detection of platelet desensitization in pregnancy-induced hypertension is dependent on the agonist used. Thromb Haemost 1991; 65: 474-7.
- 4 Janes SL, Kyle PM, Redman C, Goodall AH. Flow cytometric detection of activated platelets in pregnant women prior to the development of preeclampsia. Thromb Haem. 1995; 74: 1059-63.
- 5 Walker JJ, Cameron AD, Bjornsson S, Singer CRJ, Fraser C. Can platelet volume predict progressive hypertensive disease in pregnancy?. Am J Obstet Gynecol 1989; 161: 676-9.
- 6 Hutt R, Ogunniyi SO, Sullivan MHF, Elder MG. Increased platelet volume and aggregation precede the onset of preeclampsia. Obstet Gynecol 1994; 83: 146-9.
- 7 Ahmed Y, Sullivan MHF, Pearce JM, Elder MG. Changes in platelet function in pregnancies complicated by fetal growth retardation. Eur J Obstet Gynecol Reprod Biol 1991; 42: 171-5.
- 8 Sullivan MHF, Fusi L, Brosens J, Elder MG. Prospective modulation of platelet function and volumes by aspirin and dipyridamole in an at risk pregnancy. Brit J Obstet Gynecol 1992; 99: 75-6.
- 9 Ahmed Y, van Iddekinge B, Paul C, Sullivan MHF, Elder MG. Retrospective analysis of platelet numbers and volumes in normal pregnancy and in pre-eclampsia. Brit J Obstet Gynaecol 1993; 100: 216-20.
- 10 Bath PMW. The routine measurement of platelet size using sodium citrate as the anticoagulant. Thromb Haemost 1993; 70: 687-90.
- 11 Sullivan MHF, Elder MG. Changes in platelet reactivity following aspirin treatment for pre-eclampsia. Brit J Obstet Gynaecol 1993; 100: 542-5.
- 12 Beaufils M, Uzan S, Donsimoni R, Colau JC. Prevention of preeclampsia by early antiplatelet therapy. Lancet 1985; i: 840-2.
- 13 Wallenburg HCS, Dekker GA, Makovitz JW, Rotmans P. Low dose aspirin prevents pregnancy-induced hypertension and preeclampsia in angiotensin sensitive primigravidae. Lancet 1986; i: 1-3.
- 14 Elder MG, De Swiet M, Robertson A, Elder MA, Flloyd E, Hawkins DF. Low-dose aspirin in pregnancy. Lancet 1988; i: 410.
- 15 Benigni A, Gregorini G, Frusca T, Chiabrando C, Ballerini S, Valcamonico A. et al. Effect of low dose aspirin on fetal and maternal generation of thromboxane by platelets in women at risk for pregnancy-induced hypertension. New Engl J Med 1989; 321: 357-62.
- 16 Schiff E, Peleg E, Goldenberg M, Rosenthal T, Ruppin E, Tamarkin M. et al. The use of aspirin to prevent pregnancy-induced hypertension and lower the ratio of thromboxane A2 to prostacyclin in relatively high risk pregnancies. New Engl J Med 1989; 321: 351-6.
- 17 McParland P, Pearce JM, Chamberlain GVP. Doppler ultrasound and aspirin in recognition and prevention of pregnancy-induced hypertension. Lancet 1990; 335: 1552-5.
- 18 Balasch J, Carmona F, López-Soto A, Font J, Creus M, Fábregues F. et al. Low dose aspirin for prevention of pregnancy losses in women with primary antiphospholipid syndrome. Human Reprod 1993; 8: 2234-9.
- 19 Uzan S, Beaufils M, Breart G, Uzan M, Paris J. Prevention of intrauterine growth retardation and preeclampsia by small doses of aspirin. Results of the French multicenter trial EPREDA and comparison with data in the literature; value of uterine Doppler. J Gynecol Obstet Biol Reprod Paris 1992; 21: 315-8.
- 20 Italian study of aspirin in Pregnancy.. Low-dose aspirin in prevention and treatment of intrauterine growth retardation and pregnancy-induced hyper-tension. Lancet 1993; 341: 396-400.
- 21 Hauth JC, Goldenberg RL, Parker CR, Philips JB, Copper RL, DuBard MB. et al. Low dose aspirin therapy to prevent preeclampsia. Am J Obstet Gynecol 1993; 168: 1083-91.
- 22 Sibai BM, Caritis SN, Thom E, Klebanoff M, McNellis D, Rocco L. et al. Prevention of preeclampsia with low dose aspirin in healthy nulliparous pregnant women. New Engl J Med 1993; 329: 1213-8.
- 23 Viinikka L, Hartikainen-Sorri AL, Lumme R, Hiilesmaa V, Ylikorkala O. Low dose aspirin in hypertensive pregnant women: effect on pregnancy outcome and prostacyclin-thromboxane balance in mother and newborn. Brit J Obstet Gynaecol 1993; 100: 809-15.
- 24 CLASP (Collaborative Low-dose Aspirin Study in Pregnancy) Collaborative Group.. CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. Lancet 1994; 343: 619-29.
- 25 ECPPA Collaborative Group.. ECPPA: randomised trial of low-dose aspirin for the prevention of maternal and fetal complications in high risk pregnant women. Brit J Obstet Gynaecol 1996; 103: 39-47.