Adherence to Universal Aspirin Compared to Screening Indicated Aspirin for Prevention of Preeclampsia

NCT ID: NCT04797949

Last Updated: 2025-04-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

WITHDRAWN

Clinical Phase

PHASE4

Study Classification

INTERVENTIONAL

Study Start Date

2021-03-03

Study Completion Date

2022-06-01

Brief Summary

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There are data showing that a majority of pregnant women may not be accurately identified as high risk through screening and therefore, not receiving prophylactic low dose aspirin as recommended. This leads to missing many patients who would benefit from aspirin administration. Aspirin is an effective, affordable and safe intervention and its universal use in pregnancy has been proposed as the answer to help mitigate risk of significant morbidity from preeclampsia. However, adherence to aspirin in women at low risk compared to those deemed at high risk of preeclampsia has never been studied. One of the arguments against universal aspirin administration is the concern that universal receipt would change the compliance in those at high risk although there are no data to support this concern. To address the lack of data on differences in adherence, our goal in this proposal is to assess whether there is a difference in adherence to low dose aspirin (81 mg) in women at high risk of preeclampsia as indicated by USPSTF risk algorithm when compared to those women randomized to universal use.

Detailed Description

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Research objective- To compare adherence to low dose, 81mg of aspirin in women considered high risk by USPSTF criteria vs universal receipt.

Hypothesis: Women considered high risk by USPSTF criteria will have better adherence to low dose aspirin than women randomized to universal receipt.

Study Design: Randomized trial

Population: English or Spanish speaking women between 10-20 weeks of gestation receiving their care at Women \& Infants Hospital, with a plan to deliver at Women \& Infants Hospital

Once enrolled, patients will then be randomized to USPSTF criteria to determine if they qualify for aspirin or to universal aspirin receipt. Once randomized, patients will undergo video pill counts at multiple intervals in their prenatal care (monthly).

Conditions

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Medication Adherence Preeclampsia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Patients are randomized to receiving aspirin knowing their risk status vs those who are randomized to universal receipt.
Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors
The study personnel who will perform pill counts will be masked to the study arm.

Study Groups

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Randomized to USPSTF Criteria

Women randomized to knowing their risk of preeclampsia and therefore, candidates for low dose aspirin.

Group Type ACTIVE_COMPARATOR

Low-dose aspirin

Intervention Type DRUG

Women will be prescribed 81 mg of aspirin to take daily during pregnancy.

Randomized to Universal aspirin receipt

Women randomized to receiving low dose aspirin without knowing their risk status.

Group Type ACTIVE_COMPARATOR

Low-dose aspirin

Intervention Type DRUG

Women will be prescribed 81 mg of aspirin to take daily during pregnancy.

Interventions

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Low-dose aspirin

Women will be prescribed 81 mg of aspirin to take daily during pregnancy.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Pregnancy between 10 to 20 weeks gestation by best available dating
* 18 years of age or older
* Fluency in English or Spanish

Exclusion Criteria

• Contraindication to aspirin use
Minimum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Women and Infants Hospital of Rhode Island

OTHER

Sponsor Role lead

Responsible Party

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Sebastian Ramos

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Sebastian Z Ramos, MD

Role: PRINCIPAL_INVESTIGATOR

Women and Infants Hospital

Locations

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Women and Infants Hospital

Providence, Rhode Island, United States

Site Status

Countries

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United States

References

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Ayala NK, Rouse DJ. A Nudge Toward Universal Aspirin for Preeclampsia Prevention. Obstet Gynecol. 2019 Apr;133(4):725-728. doi: 10.1097/AOG.0000000000003167.

Reference Type RESULT
PMID: 30870274 (View on PubMed)

Mone F, Mulcahy C, McParland P, Breathnach F, Downey P, McCormack D, Culliton M, Stanton A, Cody F, Morrison JJ, Daly S, Higgins J, Cotter A, Hunter A, Tully EC, Dicker P, Alfirevic Z, Malone FD, McAuliffe FM. Trial of feasibility and acceptability of routine low-dose aspirin versus Early Screening Test indicated aspirin for pre-eclampsia prevention (TEST study): a multicentre randomised controlled trial. BMJ Open. 2018 Jul 28;8(7):e022056. doi: 10.1136/bmjopen-2018-022056.

Reference Type RESULT
PMID: 30056389 (View on PubMed)

Shanmugalingam R, Wang X, Motum P, Fulcher I, Lee G, Kumar R, Hennessy A, Makris A. Clinical Influence of Nonadherence With Prophylactic Aspirin in Preventing Preeclampsia in High-Risk Pregnancies: A Multicenter, Prospective, Observational Cohort Study. Hypertension. 2020 Apr;75(4):1125-1132. doi: 10.1161/HYPERTENSIONAHA.119.14107. Epub 2020 Mar 2.

Reference Type RESULT
PMID: 32114852 (View on PubMed)

Werner EF, Hauspurg AK, Rouse DJ. A Cost-Benefit Analysis of Low-Dose Aspirin Prophylaxis for the Prevention of Preeclampsia in the United States. Obstet Gynecol. 2015 Dec;126(6):1242-1250. doi: 10.1097/AOG.0000000000001115.

Reference Type RESULT
PMID: 26551178 (View on PubMed)

Henderson JT, Whitlock EP, O'Connor E, Senger CA, Thompson JH, Rowland MG. Low-dose aspirin for prevention of morbidity and mortality from preeclampsia: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2014 May 20;160(10):695-703. doi: 10.7326/M13-2844.

Reference Type RESULT
PMID: 24711050 (View on PubMed)

Other Identifiers

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1581227

Identifier Type: -

Identifier Source: org_study_id

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