(808) Timing of aspirin discontinuation prior to delivery and risk of peripartum bleeding complications

There are limited data to guide timing of aspirin discontinuation prior to delivery. We assessed whether there was an association between timing of aspirin discontinuation and maternal and peripartum bleeding complications.

Study Design:

This was a secondary analysis of a large multicenter RCT of prophylactic tranexamic acid versus placebo in patients undergoing cesarean delivery. Participants taking daily oral aspirin during pregnancy whose discontinuation date was known were included. Participants were grouped by days of aspirin discontinuation in relation to their delivery date: on the day of delivery, 1-7 days prior to delivery, or >7 days prior to delivery. The primary outcome was a composite of transfusion of packed red blood cells or EBL >1L. Secondary outcomes were individual components of the primary outcome. Outcomes were compared across discontinuation timing groups. Adjusted ORs (95% CIs) were calculated using backwards elimination logistic regression (using characteristics associated with primary outcome) with >7 days prior to delivery as the reference group.

Results:

Of 10,993 patients in the parent trial, 1614 (15%) were on aspirin and 1571 with a known discontinuation date were included: 164 (10%) discontinued aspirin on day of delivery, 1064 (68%) from 1-7 days, and 343 (22%) >7 days prior to delivery. The primary outcome was observed in 244 (16%) of patients. After adjustments for differences in baseline characteristics (footnote), there were no significant differences in adjusted odds of outcomes by timing of aspirin discontinuation (Figure).

Conclusion:

The timing of discontinuation (in days) of aspirin prior to cesarean delivery was not associated with postpartum hemorrhage or blood transfusion.