SILDENAFIL PLUS LOW DOSE ASPIRIN FOR PREVENTION OF PREECLAMPSIA: A RANDOMIZED CONTROLLED TRIAL

Abstract

reeclampsia is defined as new-onset hypertension after 20 weeks of gestation and proteinuria and/or any of the following:thrombocytopenia (platelets < 100,000/μL), renal insufficiency (serum creatinine > 1.1mg/dL or doubling of serum creatinine in the absence of other renal disease), impaired liver function (transaminases at twice normal concentrations in IU/L), evidence of pulmonary edema or the presence of cerebral (new onset headache) or visual symptoms/disturbances (ACOG, 2013). Preeclampsia is associated with an imbalance of thromboxane and prostacyclin resulting in platelet activation and endothelial dysfunction (Correa et al., 2016). The efficacy of antiplatelet agents has thus been studied in the prevention of preeclampsia. In 2010, Bujold et al. published a systematic review suggesting that initiation of low-dose aspirin at < 16 weeks in women at high or moderate risk for preeclampsia significantly reduced the occurrence of preeclampsia (RR: 0.47, 95% CI: 0.34–0.65) (Bujold et al., 2010). A recent meta-analysis further supported the beneficial effects of low-dose aspirin initiated < 16 weeks. However, this study could find little to no reduction on the relative risk of preeclampsia, when aspirin was initiated after 16 weeks (Roberge et al., 2017). Although m ultiple studies have reaffirmed a benefit of aspirin in reducing the risk of preeclampsia, identifying the appropriate