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Meta-análisis muestra que aspirina iniciada tempranamente reduce RCIU y preeclampsia

Meta-análisis muestra que aspirina iniciada tempranamente reduce RCIU y preeclampsia

Publicado el 14.08.2010

Un meta-análisis de E.Bujold (Quebec) muestra que la administración de aspirina (en dosis bajas) en pacientes con factores de riesgo, redujo a la mitad la frecuencia de preeclampsia y RCIU cuando se administra antes de las 16 semanas (full text).

Obstet Gynecol. 2010 Aug;116(2 Pt 1):402-14.

Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis.

Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, Forest JC, Giguère Y.

Department of Obstetrics and Gynecology, Faculty of Medicine, Laval University, Québec, Canada. emmanuel.bujold@crchul.ulaval.ca


Abstract

OBJECTIVE:
To estimate the effect of low-dose aspirin started in early pregnancy
on the incidence of preeclampsia and intrauterine growth restriction
(IUGR). DATA SOURCES: A systematic review and meta-analysis were
performed through electronic database searches (PubMed, Cochrane,
Embase). METHODS OF STUDY SELECTION: Randomized controlled trials of
pregnant women at risk of preeclampsia who were assigned to receive
aspirin or placebo (or no treatment) were reviewed. Secondary outcomes
included IUGR, severe preeclampsia and preterm birth. The effect of
aspirin was analyzed as a function of gestational age at initiation of
the intervention (16 weeks of gestation or less, 16 weeks of gestation
or more). TABULATION, INTEGRATION, AND RESULTS: Thirty-four randomized
controlled trials met the inclusion criteria, including 27 studies
(11,348 women) with follow-up for the outcome of preeclampsia. Low-dose
aspirin started at 16 weeks or earlier was associated with a significant
reduction in preeclampsia (relative risk [RR] 0.47, 95% confidence
interval [CI] 0.34-0.65, prevalence in 9.3% treated compared with 21.3%
control) and IUGR (RR 0.44, 95% CI 0.30-0.65, 7% treated compared with
16.3% control), whereas aspirin started after 16 weeks was not
(preeclampsia: RR 0.81, 95% CI 0.63-1.03, prevalence in 7.3% treated
compared with 8.1% control; IUGR: RR 0.98, 95% CI 0.87-1.10, 10.3%
treated compared with 10.5% control). Low-dose aspirin started at 16
weeks or earlier also was associated with a reduction in severe
preeclampsia (RR 0.09, 95% CI 0.02-0.37, 0.7% treated compared with
15.0% control), gestational hypertension (RR 0.62, 95% CI 0.45-0.84,
16.7% treated compared with 29.7% control), and preterm birth (RR 0.22,
95% CI 0.10-0.49, 3.5% treated compared with 16.9% control). Of note,
all studies for which aspirin had been started at 16 weeks or earlier
included women identified to be at moderate or high risk for
preeclampsia. CONCLUSION: Low-dose aspirin initiated in early pregnancy
is an efficient method of reducing the incidence of preeclampsia and
IUGR.


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