Low-dose aspirin in pregnancy: 81 mg vs 162 mg - Is there a role for personalized medicine?

Area of Science:

• Obstetrics and Gynecology
• Pharmacology
• Maternal-Fetal Medicine

Background:

• Hypertensive disorders of pregnancy (HDP), including preeclampsia, are significant causes of maternal and perinatal mortality globally.
• Low-dose aspirin is the current standard for preeclampsia prevention in high-risk pregnancies, but optimal dosage remains debated.
• Current US practice uses 81 mg daily, while international evidence suggests higher doses (150-162 mg) may be beneficial.

Purpose of the Study:

• To review the biologic rationale, clinical evidence, and implementation of different aspirin doses for preeclampsia prevention.
• To explore the potential of personalized medicine in tailoring aspirin prophylaxis based on individual patient factors.
• To discuss the implications of varying aspirin responsiveness in diverse high-risk pregnancies.

Main Methods:

• Review of existing randomized trials and meta-analyses on aspirin dosing in pregnancy.
• Examination of mechanistic studies on aspirin's pleiotropic effects beyond platelet inhibition.
• Analysis of patient-level factors influencing aspirin responsiveness and efficacy.

Main Results:

• Higher-dose aspirin (150-162 mg) shows a consistent trend toward improved efficacy in selected high-risk populations.
• No significant increase in major adverse safety outcomes was observed with higher aspirin doses.
• Patient factors like obesity, multifetal gestation, and chronic hypertension may influence aspirin response.

Conclusions:

• Higher aspirin doses may offer enhanced preeclampsia prevention in specific high-risk groups.
• Personalized medicine approaches, potentially guided by biomarkers and risk stratification, could optimize aspirin prophylaxis.
• Further pragmatic trials are necessary to establish optimal dosing and ensure equitable implementation.