Prevención de la preeclampsia: actualización del uso de la aspirina

Abstract

Preeclampsia is one of the main causes of serious maternal-fetal complications and in Ecuador it is the leading cause of maternal mortality. Thus, a prevention method has been specified, the most accepted being low-dose aspirin. However, several aspects of its administration are still controversial due to the heterogeneity of the results in the investigations carried out. Objectives: to describe the current knowledge on the administration of aspirin (dose, week of gestation and interpersonal factors) for the prevention of preeclampsia in high-risk women. Methods: Comprehensive review of randomized controlled clinical trials, systematic reviews, meta-analyses, and cohort studies. The included articles were published in the period from January 2019 to January 2023, in English and Spanish, and extracted from the PubMed and Cochrane platforms. Results obtained: 24 articles were selected for data extraction and qualitative synthesis. A range of doses from 50 mg to 160 mg was obtained; being the doses greater than 80 mg those that showed greater effectiveness. Starting before 16 weeks showed a significant effect but not before 11; after 20 there is conflicting evidence. Personal characteristics and comorbidities interfere with the preventive effect. Conclusions: Even when there is no established consensus, doses equal to or greater than 80 mg of aspirin administered before 16 weeks indicate greater efficacy; however, obesity and chronic hypertension seem to determine the need for a higher dose.