Laboratory aspirin resistance and the incidence of preeclampsia under prophylactic low-dose aspirin therapy: a systematic review and meta-analysis

Abstract

A subset of pregnant women treated with prophylactic low-dose aspirin (LDA) still develop preeclampsia (PE), a severe pregnancy-related complication. It is hypothesized that laboratory aspirin resistance (LAR), which may undermine the preventive efficacy of LDA, is associated with the onset of PE. However, this association remains unclear. This study aimed to investigate the relationship between LAR and the risk of developing PE despite LDA prophylaxis, a phenomenon we operationally define as clinical aspirin resistance (CAR), through a systematic review and meta-analysis. A comprehensive literature search was conducted in PubMed, Web of Science, Google Scholar, Scopus, Embase, and the Cochrane Library. Eligible studies that assessed the association between LAR and CAR were included. A random effect model was used to pool the data and calculate the combined odds ratio (OR) along with its corresponding 95% confidence interval (CI). Eight studies were included. Substantial heterogeneity was observed in the definitions of LAR across studies, which varied by assay type, biomarker measured, and diagnostic threshold. The result did not reveal a significant association between LAR and the risk of CAR (pooled OR = 1.08, 95% CI 0.70–1.67, I 2 = 55.6%). Subgroup analyses stratified by LAR definition and LDA dosing strategy similarly showed no significant association. The current evidence is insufficient to establish or exclude a significant association between LAR and the failure of LDA prophylaxis for PE. The substantial variation in LAR definitions across studies may limit the certainty of the pooled estimate. Further research using standardized laboratory criteria and larger sample sizes is needed.