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Aspirin for the prevention and treatment of pre‐eclampsia: A matter of COX‐1 and/or COX‐2 inhibition?

Since the 1970s, we have known that aspirin can reduce the risk of pre‐eclampsia. However, the underlying mechanisms explaining this risk reduction are poorly understood. Both cyclooxygenase (COX)‐1‐ and COX‐2‐dependent effects might be involved. As a consequence of this knowledge hiatus, the optima...

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Published in:Basic & clinical pharmacology & toxicology 2020-08, Vol.127 (2), p.132-141
Main Authors: Mirabito Colafella, Katrina M., Neuman, Rugina I., Visser, Willy, Danser, A. H. Jan, Versmissen, Jorie
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description Since the 1970s, we have known that aspirin can reduce the risk of pre‐eclampsia. However, the underlying mechanisms explaining this risk reduction are poorly understood. Both cyclooxygenase (COX)‐1‐ and COX‐2‐dependent effects might be involved. As a consequence of this knowledge hiatus, the optimal dose and timing of initiation of aspirin therapy are not clear. Here, we review how (COX‐1 versus COX‐2 inhibition) and when (prevention versus treatment) aspirin therapy may interfere with the mechanisms implicated in the pathogenesis of pre‐eclampsia. The available evidence suggests that both COX‐1‐ and COX‐2‐dependent effects play important roles in the early stage of aberrant placental development and in the next phase leading to the clinical syndrome of pre‐eclampsia. Collectively, these data suggest that high‐dose (dual COX inhibition) aspirin may be superior to standard low‐dose (selective COX‐1 inhibition) aspirin for the prevention and also treatment of pre‐eclampsia. Therefore, we conclude that more functional and biochemical tests are needed to unravel the contribution of prostanoids in the mechanisms implicated in the pathogenesis of pre‐eclampsia and the potential of dual COX and/or selective COX‐2 inhibition for the prevention and treatment of pre‐eclampsia. This information is vital if we are to deduce the suitability, optimal timing and dose of aspirin and/or a specific COX‐2 inhibitor (most likely using modified forms that do not cross the placenta) that can then be tested in a randomized, controlled trial instead of the current practice of empirical dosing regimens.
doi_str_mv 10.1111/bcpt.13308
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subjects Aspirin
Aspirin - administration & dosage
Aspirin - therapeutic use
Biochemical tests
COX-2 inhibitors
Cyclooxygenase 1 - metabolism
Cyclooxygenase 2 - metabolism
Cyclooxygenase 2 Inhibitors - therapeutic use
Cyclooxygenase Inhibitors - administration & dosage
Cyclooxygenase Inhibitors - therapeutic use
Developmental stages
Dosage
Dose-Response Relationship, Drug
Eclampsia
Female
Health services
Humans
hypertension
Minireview
MINIREVIEWS
Pathogenesis
Placenta
Pre-Eclampsia - drug therapy
Pre-Eclampsia - enzymology
Pre-Eclampsia - prevention & control
Preeclampsia
Pregnancy
Prevention
pre‐eclampsia
Prostaglandin endoperoxide synthase
Prostaglandins
Prostaglandin‐Endoperoxide Synthases
Risk management
Risk reduction
title Aspirin for the prevention and treatment of pre‐eclampsia: A matter of COX‐1 and/or COX‐2 inhibition?
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