GROUP 1

ACTIVITY 1:

RESEARCH TITLE: Antiplatelet Agents for Preventing Pre-Eclampsia and Its Complications.

OVERVIEW:

According to (Gifford 2020), pre-eclampsia is defined as high blood pressure associated with
proteinuria. It occurs in the second half of pregnancy and complicates between 2% to 8% of
pregnancies. In addition, it is associated with deficient intravascular production of prostacyclin, a
vasodilator, and excessive production of thromboxane, a vasoconstrictor and stimulant of platelet
aggregation. These observations led to the hypotheses that antiplatelet agents, low‐dose aspirin in
particular, might prevent or delay development of pre‐eclampsia. This study is conducted to assess the
effectiveness and safety of antiplatelet agents, such as aspirin and dipyridamole, when given to
women at risk of developing pre‐eclampsia. Results shown that The use of antiplatelet agents reduced
the risk of proteinuric pre‐eclampsia by 18% (36,716 women, 60 trials, RR 0.82, 95% CI 0.77 to 0.88;
high‐quality evidence), number needed to treat for one women to benefit (NNTB) 61 (95% CI 45 to 92).
There was a small (9%) reduction in the RR for preterm birth <37 weeks (35,212 women, 47 trials; RR
0.91, 95% CI 0.87 to 0.95, high‐quality evidence), NNTB 61 (95% CI 42 to 114), and a 14% reduction in
fetal deaths, neonatal deaths or death before hospital discharge (35,391 babies, 52 trials; RR 0.85, 95%
CI 0.76 to 0.95; high‐quality evidence), NNTB 197 (95% CI 115 to 681). Antiplatelet agents slightly
reduced the risk of small‐for‐gestational age babies (35,761 babies, 50 trials; RR 0.84, 95% CI 0.76 to
0.92; high‐quality evidence), NNTB 146 including maternal death, baby death, pre‐eclampsia, small‐for‐
gestational age, and preterm birth) (RR 0.90, 95% CI 0.85 to 0.96; 17,382 women; 13 trials, high‐quality
evidence), NNTB 54 (95% CI 34 to 132). Antiplatelet agents probably slightly increase postpartum
hemorrhage > 500 mL (23,769 women, 19 trials; RR 1.06, 95% CI 1.00 to 1.12; moderate‐quality
evidence due to clinical heterogeneity), and they probably marginally increase the risk of placental
abruption, although for this outcome the evidence was downgraded due to a wide confidence interval
including the possibility of no effect (30,775 women; 29 trials; RR 1.21, 95% CI 0.95 to 1.54; moderate‐
quality evidence). In conclusion, administration of antiplatelet agents leads to a 17% reduction in the
relative risk of developing pre‐eclampsia. For primary prevention of pre‐eclampsia, for every 64
women treated, one case of pre‐eclampsia will be prevented. For women who are at high risk, the
results suggest that one case of pre‐eclampsia will be prevented for every 39 treated. There are also
smaller risk reductions associated with the use of antiplatelet agents of preterm birth (9%), with 61
women needing to be treated to prevent one case, and of fetal or neonatal death (14%) with 213
women needing to be treated to prevent one case. Adverse effects appear to be low although data
were not reported by all trials. The results suggest a slight increase in postpartum hemorrhage of > 500
mL. Overall, there was a 10% reduction in pregnancies with serious adverse outcomes. As most women
in this review were in trials evaluating low‐dose aspirin, the reassurance about safety may not apply to
higher doses or other agents. However, there was some indication that higher doses may be more
effective in preventing pre‐eclampsia. For the interventions and comparison in this review,
interventions varied as to dose of aspirin, gestation at commencement, and use of other treatments. In
most trials, aspirin alone was compared with placebo or no treatment. Aspirin alone was the
intervention for all nine large trials. The dose was 50 mg in one trial (Italy 1993), 60 mg in five (Brazil
1996; CLASP 1994; Jamaica 1998; USA 1993a; USA 1998), 100 mg in one (ERASME 2003) and 150 mg in
one (ASPRE 2017) Eight of these large trials used placebo for the control group, and for one (Italy 1993)
no treatment was the control intervention. Of the smaller trials using an intervention that was not
GROUP 1

aspirin alone, five used a combination of aspirin and dipyridamole or dipyridamole alone versus control
(EPREDA 1991; France 1985; France 1990; Russia 1993; S Africa 1988), one small trial used heparin and
dipyridamole versus control (Australia 1995a), another combined aspirin with vitamins C and E and fish
oil (Venezuela 2000), another compared ozagrel hydrochloride with placebo (Japan 1999) ,and one
compared trapidil with placebo (Germany 1995). Most trials used some form of placebo. One small
trial compared different duration of aspirin treatment (to 32 weeks or 36 weeks) with placebo
(Romania 2018); the two intervention groups are combined in this review.

P: Pregnant women at risk of developing pre-eclampsia

I: Antiplatelet agent in preventing pre-eclampsia (e.g. aspirin and dipyridamole)

C: Placebo treatment or no antiplatelet agent

O: Prevention of the development of pre-eclampsia and its complications

T: Mid-2nd-3rd trimester of pregnancy

Critical Question: For pregnant women at risk of developing pre-eclampsia, will the use of antiplatelet
agent such as aspirin and dipyridamole effective and safe to prevent the development of pre-eclampsia
and its complications compared to the use of placebo or no antiplatelet agent administered during the
mid-2nd to 3rd trimester of pregnancy?
GROUP 1

ACTIVITY 2:

Research Problem/Research Topic:

The effectiveness and safety of low-dose Aspirin administered to pregnant women at risk of
pre-eclampsia at the 2nd half of pregnancy

Research Objective:

The objective of this review is to confirm that antiplatelet agent, primarily aspirin in low dose
given during pregnancy, reduce the incidence of pre-eclampsia. The review will then determine the size
of effectiveness as well as its outcome and impact to the pregnant women and to their babies. It will
also explore whether the dose of the aspirin differs depending on the pregnant women’s degree of risk.

Research questions/problems (statement of the problem):

Of the concerns of the researchers, the review ought to assess the effectiveness and safety of
the use of antiplatelet agents, primarily low dose aspirin in preventing pre-eclampsia in pregnant
women.

Specifically, it sought to answer the following questions:

1. What is the desirable/specific amount of aspirin to high risk and low risk pregnant women
developing pre-eclampsia?
2. What effect does the use of low dose aspirin have on women at risk of developing pre-eclampsia
and their babies?
3. Do antiplatelet agents, primarily low dose aspirin, have clinically important benefits for women
at risk of developing pre-eclampsia and their babies?
4. Is there an increased risk of bleeding complications in women receiving aspirin? And should
patients stop taking aspiring when delivery is imminent?
GROUP 1

Agacid, Adrian Dominique

Almazan, Justine Ira
Anacleto, Aira Faith
Agcaoili, Ma. Allyssa
Baltazar, Janna Lizette
Buenavista, Julimaricon
Brigado, Nerie Anne
Cadiz, Ira Klein
Cabuyadao, Graziella
Dagdagan, Joyce Anne
Daquep, Jorynne