Analysis of Low Dose Aspirin on Platelet Aggregation Percentage in High-Risk Pregnancy Hypertension

Oktaviany Irma Wiputri1,*, Yulistiani1, Eddy Z Monsir2, Dewi Ramdani3

1Department of Clinical Pharmacy, Faculty of Pharmacy, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia.
2Department of Obstetrical and Gynaecology, Haji Teaching Hospital, Mulyorejo, Surabaya, Indonesia.
3Department of Pharmacy, Haji Teaching Hospital, Mulyorejo, Surabaya, Indonesia.

Abstract: Objective: Low dose aspirin (LDA) is one of platelet aggregation agents in high-risk pregnancy that is believed to prevent complication by inhibiting thromboxane A2 as a strong vasoconstrictor in platelet. It can inhibit platelet aggregation involved in pathophysiology of pregnancy hypertension. The aim of this study is to analyse the effect of LDA on platelet aggregation in pregnant patient with high-risk hypertension. Material and methods: A prospective observational method was conducted in this study. It was approved by the Ethics Committee of Haji Teaching Hospital Surabaya. Data was collected from July to September 2018 involving 18 patients divided into three groups who have age of 35-39 years old in the majority. The range of gestational age in this study was 19-37 weeks. Platelet aggregations on plasma were measured before and 14 – 30 days after LDA use. The collected data were statistically analyzed by using a paired t-test. Results: Platelet aggregation percentage using collagen agonists was an increase of 0.8% (p > 0.05) in the old patient group and followed by 6% (p > 0.05) in the group of patients who did not get LDA. Whereas in the group of new patients showed a decrease of 6% (p > 0.05). While ADP agonists showed that the group of new patients decreased by 17% (p > 0.05), followed by the group of patients who did not use LDA of 9% (p > 0.05) and the old patient group was 4% (p > 0.05). Conclusions: Low-dose aspirin use did not affect a decrease in platelet aggregation values.


Keywords:high risk pregnancy, low-dose aspirin, platelet aggregation.

DOWNLOAD PDF

References:
  1. Askie LM, Duley L, Henderson-Smart DJ, Stewart LA. Antiplatelet agents for Prevention of Pre-eclampsia: A Meta-Analysis of Individual Patient Data. Lancet Glob Health 2007; 369: 1791–8.
  2. Say L, Chou D, Gemmill A, Tunc AO, Moller AB, Daniels J, et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2: e323–33.
  3. Von Dadelszen P, Magee LA. Pre-eclampsia: an update. Curr Hypertens Rep 2014;16:1–14.
  4. Kementerian Kesehatan Republik Indonesia. Kesehatan Keluarga In: 2015 Profil Kesehatan Indonesia. Kementerian Kesehatan Republik Indonesia: Jakarta; 2016:114-8.
  5. Cai H, Harrison DG. Endothelial Dysfunction in Cardiovascular Disease. Circ Res 2000; 87:840-4.
  6. Al Obaidly M, Regan C, Lwaleed B, Moran N. A Role for Platelets in Normal Pregnancy. Intech Open 2015; 159-67.
  7. Atallah A, Lecarpentier E, Goffinet F, Doret-Dion M, Gaucherand P, Tsatsaris V. Aspirin for Prevention of Preeclampsia. Drugs 2017; 77: 1819-31.
  8. Navaratnam K. Platelet function and response to low-dose aspirin in Pregnancy. University of Liverpool. 2017;12-73.
  9. Sava RI, March KL, Pepine CJ. Hypertension in Pregnancy: Taking cues from pathophysiology for clinical practice. Clin Cardiol 2018; 41: 221.
  10. Siddqui IA, Jaleel A, Tamimi W, Al Kadri HMF. Role of oxidative stress in the pathogenesis of Preeclampsia. Obstet Gynecol. 2010; 282: 472.
  11. Burke N, Flood K, Murray A, Cotter B, Dempsey M, Fay L, et al. Platelet reactivity changes significantly throughout all trimesters of Pregnancy compared with the non Pregnant state: a prospective study. Int J Gynaecol Obstet 2013;120:599-1604.
  12. Golebiewska EM, Poole AW. Platelet secretion: From haemostasis to wound healing and beyond. Blood Rev 2015;29:153.
  13. Possomato-Vieira JS, Khalil RA. Mechanism of Endothelial Dysfunction in Hypertensive Pregnancy and Preeclampsia In : Khalil, R.A. Endothelium. 1st edition. United Kingdom: Elsevier; 2016:367-408.
  14. Lowe SA, Bowyer L, Lust K. The SOMANZ Guideline for the Management of Hypertensive Disorders of Pregnancy. https://www.somanz.org/documents/HTPregnancyGuidelineJuly2014.pdf (Accessed Mar 20, 2018).
  15. Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P. Diagnosis, Evaluation, and Management of the Hypertensive Disorders of Pregnancy: Executive Summary. J Obstet Gynaecolog Can 2014; 36: 416-38.
  16. Henderson-smart DJ, Duley L, Meher S, King JF. Antiplatelet agents for Preventing Pre-eclampsia and its complications. Cochrane Database Syst Rev 2007; 2: CD004659.
  17. Frontroth JP. Light Transmission Aggregometry In: Monagle, P. Haemostasis Methods and Protocol. London: Springer; 2013: 227-40.
  18. Kinouchi K, Fujita T, Narahara C, Kitamura S. Platelet function in pregnant women receiving aspirin and dipyridamole. J Anesth 2000; 14: 115-8.
  19. Koltai K, Kesmarky G, Feher G, Tibold A, Toth K. Platelet aggregometry testing: Molecular mechanism, technique, and clinical implications. Int J Mol Sci 2017;18:1-2.
  20. ACOG Hypertension in Pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Am J Obstet Gynecol 2013; 122: 1122–31.
  21. Patil A, Thames E, James A. Pharmacodynamics of low-dose aspirin in Pregnancy. Am J Obstet Gynecol. 2012; S329.
  22. Practical-Haemostasis. https://practical-haemostasis.com (Accessed Jan 25, 2018).