Abstract
BACKGROUND: For a long time, it has been proposed that aspirin might have a preventive property to reduce the risk of preeclampsia; however, recent assessments have changed the insights toward this medication. The current qualitative systematic review aims to thoroughly assess the outcomes of treatment with aspirin in high-risk preeclampsia women. MATERIALS AND METHODS: The scope of this study was to evaluate: (1) the preventive role of treatment with aspirin on high-risk pregnancies for preeclampsia, (2) the applied dose on the incidence of preeclampsia, (3) the outcome of using aspirin alone versus in combination with an anticoagulant, and (4) the outcome of aspirin discontinuation on the incidence of preeclampsia. PubMed, Scopus, Web of Science, and Embase databases were searched from January 1, 2015, to December 31, 2023. English-written studies with trial designs (randomized or nonrandomized) assessing the use of aspirin on preeclampsia prevention among high-risk women for this phenomenon were included. Three authors independently surfed the databases and selected the studies; in case of any disagreement, the problem was resolved by the fourth author. Then, the papers were fully screened and those that met the study criteria were individually evaluated. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials was applied categorizing the studies into low-moderate and high risk of bias. RESULTS: Finally, data from twenty-three studies on 15,764 high-risk preeclampsia individuals with singleton pregnancies were extracted. Fourteen, 4, and 5 studies had low, moderate, and high risk of bias. Aspirin use regardless of its dosage was not remarkably associated with reduced risk of preeclampsia in the majority of studies. Besides, the time of initiation or discontinuation did not affect the outcomes. Moreover, aspirin combination with anticoagulant was not necessarily superior over aspirin alone. CONCLUSION: Based on our findings, the body of evidence majorly found no remarkable role for prophylactic aspirin use to prevent preeclampsia incidence at any time during pregnancy; however, promising data, particularly in higher doses and earlier initiation of aspirin, have been noted.