Aspirin and bleeding risk in pregnancy: a clinical review

Low-dose aspirin is recommended by nearly every major obstetric society for women at high risk of preeclampsia. There is consistent and robust data surrounding preeclampsia prevention, particularly severe early-onset disease; however, there are signals in the data that question the safety of continuation until delivery due to potential increased risk of bleeding. There is robust data from the non-pregnant population that demonstrates concern with long-term aspirin use and bleeding risk. The obstetric literature lacks such robust studies around bleeding concerns, particularly around the time of delivery in individuals using aspirin in pregnancy. This review provides a comprehensive, review of bleeding and hemorrhage risk associated with aspirin use in pregnancy and highlights the consideration for aspirin discontinuation prior to delivery.