Aspirin reduces Pre-Eclampsia by 24 %. Preterm birth by 14% & intrauterine growth retardation by 20%-Prof. Naela Tarique

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 New and Emerging indications for Aspirin Therapy

Aspirin reduces Pre-Eclampsia by 24 %. Preterm
birth by 14% & intrauterine growth retardation
by 20%-Prof. Naela Tarique

Further studies needed to confirm benefit of Aspirin in
prevention of Cataract the leading cause of blindness-Prof. Saeed

LAHORE: Aspirin plays a major role in many Obstetrical and Gynecological conditions. Some important ones include Pre-Eclampsia, Intrauterine Growth Retardation, Recurrent Pregnancy Loss and Deep Vein Thrombosis. This was stated by Prof. Dr. Naela Tarique Head of the Department of Obstetrics & Gynaecology at Azra Naheed Medical College. She was participating in the panel discussion on new and emerging indications for Aspirin Therapy during the National Medical Conference organized by AZNMC in collaboration with Pakistan Aspirin Foundation here on April 28, 2018.

Pre-Eclampsia

Pre eclampsia, she said, is development of hypertension in pregnancy at or after 20 weeks. Blood pressure is equal to or greater than 140/90 plus proteinuria is greater than or equal to 3g / 24 hours in urine. It effects 2-8 % of pregnancies and is second leading cause of maternal mortality worldwide. In normal pregnancy prostacyclin increases markedly.


Prof. Ejaz Ahmad Vohra and Prof. M. Akbar Chaudhry former Presidents of Pakistan Aspirin Foundation
presenting mementoes to from (L t R) Prof. Naela Tarique, Prof. Shaheen Kausar and Prof. M. Saeed
during the panel discussion on new and emerging indications of Aspirin Therapy
at the National Medical
Conference organized by AZNMC in collaboration with Pakistan Aspirin Foundation on April 28, 2018.

It inhibits platelet aggregation and causes vasodilation. In pre-eclampsia there is dominance of Thromboxane A2 over prostacyclin that is strong vasoconstrictor. According to CLASP (Collaboration low dose Aspirin Study in Pregnancy), prophylactic use of Aspirin decreases pre-eclampsia in 12% of pregnancies. According to US preventive services task force prophylactic, 60-150mg Aspirin results in reduction in Pre-Eclampsia by 24 %. Preterm birth by 14% & intrauterine growth retardation by 20%

Intrauterine Growth Retardation

Referring to Intrauterine Growth Retardation Prof. Naela Tarique said that it results when estimated fetal weight is below the 10th percentile for its gestational age as determined through ultrasound. Its incidence is 10% in general population. Its pathogenesis is inadequate trophoblast invasion of spiral arteries leading to decreased perfusion of intra cotyledon space resulting in abnormal development of terminal villi. It decreases blood flow and impairs transfer of oxygen and nutrients to the fetus. Aspirin decreases occurrence of Intrauterine Growth Retardation in women at increased risks. For this condition Aspirin 75-80 mg Tablet daily is the recommended dose for prevention of Intrauterine Growth Retardation in mothers at high risk for pre-eclampsia. ACOG (American College of Gynecology), WHO (World Health Organization), NICE guidelines (National Institute for Health and Care Excellence) and AHA (American Heart Association all recommend prophylaxes with aspirin in Intrauterine Growth Retardation.

Recurrent Pregnancy Loss

Recurrent Pregnancy Loss Prof. Naela Tariq stated means three or more consecutive miscarriages before 10 weeks of pregnancy or one or more morphologically formed fetal loss after 10 weeks of gestation or one or more preterm birth before 34 weeks due to placental pathology. There are multiple causes of recurrent pregnancy losses among which treatable cause include Antiphospholipid Antibody Syndrome. Mechanism includes activation of compliment pathway at maternal fetal interphase resulting in local inflammatory response and thrombosis of utero placental vasculature. Aspirin inhibits platelet cyclooxygenase irreversibly and decreased production of thromboxane A2 and causes vasodilatation thus preventing thrombosis.

Deep Vein Thrombosis

Speaking about DVT, she said, pregnancy is a pro thrombotic state because it has all components of Virchow’s Triad that is stasis, vessel wall injury and hyper coagulability thus causing thrombosis. Deep Vein Thrombosis is a blood clot that forms in a vein deep in the body mostly in lower leg or thigh. Pathogenesis of clotting mechanism in vein is tissue factor that leads to thrombin generation and activation of white cells. This leads to platelet aggregation and fibrin formation. Platelet aggregation plays an important role in development and propagation of deep vein thrombosis. Aspirin blocks Cyclooxygenase – II and results in decreased platelet aggregation. It also causes inhibition of local expression of inflammatory mediators including cytokines and Cyclooxygenase – II and thus inhibits thrombotic process.

Aspirin in Ophthalmology

Prof. Dr. Muhammad Saeed from Dept. of Ophthalmology at Azra Naheed Medical College was another member of the panel of experts who participated in the panel discussion. Highlighting the use of Aspirin in ophthalmology, he pointed out that it seems we are far behind in getting benefits of this wonder drug. In mid & late 90’s few studies were conducted on the role of Aspirin for the prevention of cataract. In these studies, the postulated mechanism by which aspirin could affect progression of cataract was; acetylation of lens protein & decrease of glycaemia. None of these studies were specifically designed to test the effect of aspirin on cataract. Strangely enough to date very few if any studies have been conducted to further highlight the role of aspirin in preventing cataracts. He was of the view that there is a strong need to carry out still more studies to explore the potential benefits of this wonder drug for the prevention of one of the most common causes of reversible blindness and decrease to some extent the ever rising burden of cataract surgery all over the world particularly in developing countries. Other potential areas where benefit of Aspirin can be explored are treatment of pterygium, certain types of conjunctivitis especially allergic conjunctivitis, uveitis and control of postoperative inflammation, Prof. Saeed remarked. 

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