Antenatal Platelet Response On Aspirin and Correlation With HDP (Hypertensive Disorders of Pregnancy) (APROACH)

Thomas Jefferson University

Status: Completed

Conditions: Preeclampsia

Treatments: Drug: Aspirin 81 mg

Study type: Observational

Funder types: Other; NIH

Identifiers

NCT04295850

R21HD101127 (U.S. NIH Grant/Contract)

19F.887

Details and patient eligibility

About

This proposal has three aims to characterize the relationship between aspirin therapy, platelet function response, and prevention of hypertensive disorders of pregnancy (HDP) through a prospective, cohort study using pharmacokinetics, pharmacodynamics, pharmacogenomics and bioinformatics. The results of this proposal will provide necessary data for prospective study on individualized aspirin dose adjustment for prevention of HDP.

Full description

This proposal has four aims to characterize the relationship between aspirin therapy, platelet function response, and prevention of HDP through a prospective, cohort study using pharmacodynamics, pharmacogenomics and bioinformatics. The results of this proposal will provide necessary data for prospective study on individualized aspirin dose adjustment for prevention of HDP.

Aim 1: Establish pharmacodynamic endpoints for aspirin in prevention of HDP Hypothesis: PFA-100 closure time and serum thromboxane/urinary dehydrothromboxane-B2 (dTX-B2) are pharmacodynamic markers of aspirin response and are predictive of HDP high risk pregnant patients.

Aim 2: Explore aspirin pharmacogenetics by assessing the relationship between platelet receptor genotype, aspirin response, and prevention of HDP Hypothesis: Platelet receptor genotype is associated with race and may result in reduced platelet response to aspirin therapy, and increased incidence of HDP.

Aim 3: Assess the utility of circulating microRNA as a marker of aspirin response in pregnancy and risk of HDP Hypothesis: Quantitative expression of selected miRNAs are biomarkers for response to aspirin therapy and risk of HDP.

Aim 4: Evaluate aspirin pharmacokinetics/pharmacodynamics Hypothesis: Individual factors influence aspirin pharmacokinetics/pharmacodynamics and may impact individual dosing of aspirin

Enrollment: 130 patients

Sex: Female

Ages: 10 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Pregnant singleton, <16 weeks' gestation
• At least one high risk factor for preeclampsia: prior preeclampsia, chronic hypertension, pregestational diabetes, chronic kidney disease, lupus, antiphospholipid antibody syndrome

Exclusion criteria

• Contraindication to aspirin
• Current or planned use of any other anticoagulation
• Use of aspirin in pregnancy prior to enrollment
• Known platelet disorder at time of enrollment

Trial design

130 participants in 1 patient group

Low Dose Aspirin

Description:

Pregnant singletons at high risk for preeclampsia based on: * at least one high risk factor for preeclampsia: prior preeclampsia, chronic hypertension, pregestational diabetes, lupus, antiphospholipid antibody syndrome, or chronic kidney disease. OR * at least two of the following: BMI\>30, black race, state insurance, IVF pregnancy, advanced maternal age, nulliparous or \>10yr from last delivery, prior adverse pregnancy outcome who are planning to, but have not yet started, aspirin therapy \<16 weeks' gestation. Patients will take 81mg aspirin as prescribed.

Treatment:

Drug: Aspirin 81 mg