CLASP

Question 1

CLASP: Name and author

Answer 1

Redman et al 1994
Collaborative Low Dose Aspirin Study in Pregnancy
CLASP: An RCT of low dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women

Question 2

Population, inclusion and exclusion criteria

Answer 2

Population
Multicentre - 16 countries
	9364 women
		Between 12-32 weeks
		At risk of pre-eclampsia (not defined - "in the opinion of the responsible clinician")
			Both prophylactic and therapeutic entry allowed
				74% pre-eclampsia prophylaxis
				12% IUGR prophylaxis
				11% PET treatment
				3% IUGR treatment
			Purposefully heterogenous
			Intention to treat analysis
			99.4% follow up

Exclusion: bleeding risk, asthma, allergy to aspirin, high likelihood of immediate delivery

Question 3

Intervention and primary outcome

Answer 3

Intervention
60mg aspirin daily
Placebo

Primary outcome
Development of proteinuric pre-eclampsia

Question 4

Results: primary outcome and other 5 findings

Answer 4

12% reduction in proteinuric pre-eclampsia but not statistically significant
No difference in women entered for prophylactic or therapeutic indications
Effect was great if commenced <20 weeks

Aspirin reduced the likelihood of delivery before 37 weeks (19% vs 22%) - statistically significant reduction, and the effect was greater in women with pre-eclampsia. However, this did not impact on survival
No difference in birth weight
No difference in stillbirth or neonatal death
Aspirin associated with abruption and APH but not statistically significant
No impact on epidural complications
No difference in neonatal/fetal haemorrhag

Question 5

Take home message

Answer 5

Take home message
- Aspirin use from early pregnancy can delay delivery in women with early onset pre-eclampsia
Aspirin has a good safety profile in pregnancy