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Aspirin therapy and risk of pregnancy loss in patients with ET
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A retrospective analysis assessed the fetal and maternal outcomes and associated factors of 200 pregnancies in 100 patients with essential thrombocythemia (ET), including the effect of aspirin treatment.1 Results from this analysis were published in the American Journal of Hematology by Gangat et al.1 |
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The live birth rate was 72%, with most of the unintentional fetal losses occurring in the first trimester (24%). Fetal complications other than pregnancy loss were reported in 7% of patients, including preterm birth (3%), intrauterine growth restriction (3%), and neonatal intensive care admission (2%). Maternal complications occurred in 13% of patients, and included major hemorrhage (7%), preeclampsia (6%), venous thrombosis (1%), hemolysis with elevated liver enzymes and low platelets (1%), and placental abruption (0.5%). |
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Treatment with aspirin (n = 135) when compared with no treatment or treatment other than aspirin (n = 65) reduced the risk of pregnancy loss (16% vs 49%; p < 0.01) and first-trimester pregnancy loss (14% vs 45%; p < 0.01) in patients with ET, including lower incidences of first-trimester pregnancy loss in patients with mutated JAK2 (18% vs 50%; p < 0.01) or mutated CALR (8% vs 43%; p < 0.01). This suggests aspirin should be considered a standard preventive measure in managing pregnancies in patients with ET. |
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Aspirin use was also associated with a lower incidence of maternal venous thrombosisduring pregnancy in patients with ET (0% vs 3%, p = 0.03), reinforcing its dual protective role in both fetal and maternal outcomes. |
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Systemic anticoagulation, either antepartum or postpartum, did not significantly reducefetal or maternal complications, indicating that aspirin might be sufficient in most cases and limiting the need for more intensive anticoagulation strategies. |
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First-trimester unintentional fetal loss rates were higher in patients with prior pregnancy loss (43% vs 18%; p < 0.01) and patients with diabetes mellitus (DM; 67% vs 23%; p = 0.02) than in patients without. In addition, DM and CALR mutations were key predictors of maternal complications, with DM linked to preeclampsia (33% vs 5%; p = 0.03) and CALR mutations associated with an increased risk of hemorrhage (13% vs 4%; p = 0.05). This highlights the need for close monitoring and tailored management strategies in these higher-risk subgroups. |
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