CLASP - A RANDOMIZED TRIAL OF LOW-DOSE ASPIRIN FOR THE PREVENTION ANDTREATMENT OF PREECLAMPSIA AMONG 9364 PREGNANT-WOMEN

Authors
BEROYZ G CASALE R FARREIROS A PALERMO M MARGULIES M VOTO L FABREGUES G RAMALINGAM R DAVIES T BRYCE R BOYD W CARMODY F KING J VACCA A FAY R WALTERS W ANTONAS B BENNETT P BROOM T CROWTHER C DERHAM R GEORGE K HAGUE W HASENHOHR G HEYSEN D KORNMAN L OLOUGHLIN S MORRIS D PRIDMORE B ROBINSON J SVIGOS D SWEET R BEALE M BENNETT M BOSCH E FISHER C HORRAUTZ S SYMINGTON I SZIRT A FORBES K FREEMAN A POPPER E WILSON J PERMEZEL M BOWDITCH J REYNOLDS G MOULINASSE R BIETLOT Y KIRKPATRICK C COULON R DELVOYE P DEMATOS CF SIMONINI S LEJEUNE B NEERDAELS C ALEXANDER S GOESSENS L HANSSENS M SPITZ B VANASSCHE A WECKHUYSEN R PARBOOSINGH J HARMAN C REY E BURROWS R BELCHER J GARNER P SYLVAIN J NIMROD C THOMAS B DEININGER F LAO T LI C FRIEDMAN S BORNSTEIN J SHALIT A MATZKEL A POMERANZ M GELSNER M MANKUTA D WIZNITZER A LEVINE S ADEEB N CHANDRAN R NASRI N SHARIFF J ANSELL D LAKE Y GOROCHOVA L MERIAKRI V ROMANUGA N DOTZ I SHEUV B VIKHLYAEVA E ANDREEV K GOLUBEVA L GORODCOV V ADELANTADO J SANTONJA J HOLMBERG H BUCHHAVE P LEANDERSSON U LILJESTRAND J RYDHSTROEM H SWEDIN G BJORKLUND A GENNSER G SANDEN MC DAHLGREN S HAMMARBACK S SMEDS A SIDENVALL M ENEROTH E SZABOLCS A DANIELSSON I LINDQVIST P HOGSTEDT S WALLENBURG H BREMER H BRIET J DEBIEMEYERINK A DONKERS B LAMPING P SCHIERBEEK J VANDERLEEUWHARMSEN L THE H VANBODEGOM F VANEGMONDLINDEN A FLU P KUIJKEN J MORREL B STRAUB M VIERHOUT M KEIRSE M VANROOSMALEN J HOHNER C HUTTEN J BENNEN J ROEX A WIJFFELS T OOSTERHOFF H OTTEN J VANDERKLEI T RAMONDT J VANDERMOER P DEGRAAFF J SIJSMA E DEGREVE O SMIT D SMULDERS P NIJHUIS J ZONDERVAN H LIND J SCHOOT B MONKHORST M STUT J VANDAM L VANOTTERLO L VLAANDEREN W EGGENS J SANTEMA J VERHOEFF A HAMID S JOHN I KHAN G SHAH S SHEIKH E SINHA C ABRAMOVICH D CAMPBELL D FISHER P GALL S HALL M JANDIAL V PARKIN D SMITH N SUTHERLAND H SWAPP G TEMPLETON A TERRY P KALAM A MAGEE S MARTIN D SPEARING G ALDERMAN B MURRAY A SUTHERST J HYATT D SAUNDERS P BURGESS S COCHRANE G WHITE A ARMSTRONG M MCNICHOL E OSBOURNE G PRICE J CRICHTON J EVANS D ANDERSON R HULL M JAMES D NIVEN P STIRRAT G WARDLE P GARDNER P PADGETT L ALAILY A NASH G GINZ B SMITH M RICHARDS C ARMAR A ARMSTRONG N MANNING E PERSAD K COLLINGWOOD M COLLINS R CROWTHER J FARRELL B HAFNER B HANDOLL H HEINEMAN J KNIGHT S MEAD G RADLEY A SPENCE S REID W TREHARNE I HEASLEY R LOWRY D MYLES T WALLACE R GEALS M GORDON G TRAIN T HUTCHON D MACDONALD J STOREY R ANDERSON G WORTH R ERIAN J MCQUEEN J TATFORD E TERRY M NEALE R HOWAT R KENNEDY J MACNAUGHTON M MCEWAN H WALKER J HUTCHESON R KEMP V READ M SIMMS M SWINGLER G HUSEMEYER R CHAPMAN M MAXWELL D ELDER M FUSI L HAWKINS D NICOLINI U WINSTON R BURTON E FAIRBANK J SIMMONS S SPING J TRICKEY N EVANS D GILLARD M HUDSON C SETCHELL M WATHEN N CANTY S WHITELEY P CAMPBELL J FEENEY J HAY D IMRIE A PALMER A PURDIE D SPECK E TYRRELL S MCLEAN J BROWN V DUNCAN S JOHNSON D MILLAR D BUCKLEY D CHARNOCK M DOVE P ELLIS J GILLMER M MCVITTIE J MANNION V REDMAN CWG SELLERS S TURNBULL A NEWMAN M CAMPBELL S CARDOSO L GIBB D HARRINGTON K PARSONS J NICOLAIDES K STUDD J DIXON R GIE C PICKLES C SEAR R GRAHAM R KIRWAN P SMITH G ANWAR M ALAZZAWI F DAVIDSON A DECHAZEL R DRIFE J GILL F LANG G MACAFEE J MACVICAR J NAFTALIN N NEUBERG R TAYLOR D LEAVER E TIMOTHY I CRICHTON J BREESON A LAMB M VELACOTT I VERNER V HORWELL D LOBB M SELIGMAN S SCOTT A HALL S MACKENZIE W SMITH E VETHANAVAGAN S VERZIN J WEIR P WHITE R CLARK H FAWDRY R LYNCH C MCCUNE G BOWENSIMPKINS P CALVERT J EMERY S JACKSON W STOKES I WARD A BROWNING A COX C LITTLE D STIBBE H MCINTOSH A SNODGRASS C WAGSTAFF T HOWIE P TAYLOR D BIBBY J DAVIES W ELLIOTT B SHAXTED E MCGARRY J DAW E BAKER K CLUBB A GOUGH J GRANT M MENON V OBHARI M OBRIEN P REDMAN C BROWN R RYALL A WALTON S BAKER J BRUCE J LIU D JOHNSON I TYACK A COWIE D NYSENBAUM A BAMFORD P GARRIOCH D HILL J GRANT A FELTON D HACKMAN B FALCONER A FREEMAN F GREENE K JACKSON J HUNTER G GRATTON D MAULIK T YOUSSEF H BANWELL G HARTWELL R WILSON P BOND A FORBESSMITH P BARRON L DAVISON J DUNLOP W LIND T TACCHI D BALFOUR R MUTCH L COLTART T DESWIET M EDMONDS D LOEFFLER F MALVERN J MORRIS D OSBOURNE J RODECK C SIMS C SPENCER J BONE C MACDONALD A DREW N BALLARD R THONET R WORTH R HANNA L MORCOS S HOLT E COOPER J CALLEN P FOZZARD C GRUNDY M STANLEY S DANIEL D GOLDING R WIENER J BUCKINGHAM M HEARD M LETCHWORTH A BOOMLA K CLARK A GRUDZINSKAS J HARTGILL J ORAM D ROBSON J SAVAGE W BLUNT V LANE J OWEN A REDFORD D BEARD R BOSTOCK J MEASDAY B MELVILLE H DORNAN J TRAUB A UTIDJIAN M AULD A KRASZEWSKI A MACK D MCDOUGALL N MOWAT J DOCHERTY P MCKENNA D SMEDLEY G WILDE J SMITH R WATNEY P MCDONNELL J TROMAMS P CALDER A GLASIER A GREER I JOHNSTONE F LISTON W LIVINGSTONE J NEILSON J SMITH S WEST C BULLOUGH C JONES A MACKAY G COOPER K RUOSS C JAMES D JOYCE D MCCOY D MCLEOD F SAVAGE P SMITH P TURNER G KANE L ROSENBERG D SHANNON R BROMHAM D BUCHAN P CROMPTON A
Citation
G. Beroyz et al., CLASP - A RANDOMIZED TRIAL OF LOW-DOSE ASPIRIN FOR THE PREVENTION ANDTREATMENT OF PREECLAMPSIA AMONG 9364 PREGNANT-WOMEN, Lancet, 343(8898), 1994, pp. 619-629
Citations number
29
Categorie Soggetti
Medicine, General & Internal
Journal title
Lancet → ACNP
ISSN journal
01406736
Volume
343
Issue
8898
Year of publication
1994
Pages
619 - 629
Database
ISI
SICI code
0140-6736(1994)343:8898<619:C-ARTO>2.0.ZU;2-T
Abstract
Pre-eclampsia is a common and serious complication of pregnancy that a ffects both mother and child. Review of previous small trials of antip latelet therapy, particularly low-dose aspirin, suggested reductions o f about three-quarters in the incidence of pre-eclampsia and some avoi dance of intrauterine growth retardation (IUGR), but larger trials hav e not confirmed these results. In our multicentre study 9364 women wer e randomly assigned 60 mg aspirin daily or matching placebo. 74% were entered for prophylaxis of pre-eclampsia, 12% for prophylaxis of IUGR, 12% for treatment of pre-eclampsia, and 3% for treatment of IUGR. Ove rall, the use of aspirin was associated with a reduction of only 12% i n the incidence of proteinuric pre-eclampsia, which was not significan t. Nor was there any significant effect on the incidence of IUGR or of stillbirth and neonatal death. Aspirin did, however, significantly re duce the likelihood of preterm delivery (19.7% aspirin vs 22.2% contro l; absolute reduction of 2.5 [SD 0.9] per 100 women treated; 2p = 0.00 3). There was a significant trend (p = 0.004) towards progressively gr eater reductions in proteinuric preeclampsia the more preterm the deli very. Aspirin was not associated with a significant increase in placen tal haemorrhages or in bleeding during preparation for epidural anaest hesia, but there was a slight increase in use of blood transfusion aft er delivery. Low-dose aspirin was generally safe for the fetus and new born infant, with no evidence of an increased likelihood of bleeding. Our findings do not support routine prophylactic or therapeutic admini stration of antiplatelet therapy in pregnancy to all women at increase d risk of pre-eclampsia or IUGR. Low-dose aspirin may be justified in women judged to be especially liable to early-onset pre-eclampsia seve re enough to need very preterm delivery. In such women it seems approp riate to start low-dose aspirin prophylactically early in the second t rimester.