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In randomized controlled trials, 35,000 women
have now taken aspirin. There is evidence that there's reduction in preterm births and in
perinatal mortality. It is statistically significant but a questionably clinically
significant finding. One of the possibilities is that there are subsets of patients. The
doses were not the same in all the studies. The hypothesis that guided this study was
prostocylcin thromboxane imbalance, and the idea was that if you give a very low dose of
aspirin you'll only affect the production of prostaglandin in some of the studies but you
lose a lot of other aspirin's effect. So it could be that asprin is effective for reasons
that we didn't know of. There's now an attempt being done at Oxford to get as much of the
primary data as they can for these 35,000 people so they can identify subsets of people
for which there was value. From a clinician's perspective it's certainly the low risk
patients. This is not a significant enough association to justify treating probably 250
women. |