Cardiology AdvisorSMFM: Routine Aspirin Dispensation Tied to Lower Odds of Severe Preeclampsia

Universal aspirin dispensation at the first prenatal visit reduced preeclampsia with severe features by 29% in a cohort of 18,457 high-risk patients, with no increase in postpartum hemorrhage or placental abruption.

🔬 Clinical Considerations

• 162 mg daily aspirin initiated at ≤16 weeks reduced severe preeclampsia from 7% to 5% across the full cohort
• Chronic hypertension patients saw 0.72x the SPE risk; those without chronic hypertension saw 0.63x the risk
• Postpartum hemorrhage actually decreased from 9.5% to 8.9%, countering theoretical bleeding concerns
• Preterm delivery before 37 weeks dropped from 10% to 9%; delivery before 34 weeks remained unchanged

🎯 Practice Applications

• Dispense 162 mg aspirin directly at the first prenatal visit for all high-risk patients ≤16 weeks
• Counsel patients that aspirin did not increase hemorrhage risk in this large cohort
• Document aspirin initiation timing, as delay beyond 16 weeks excluded patients from benefit
• Monitor for SPE regardless of aspirin use, as protection was significant but not absolute

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