고위험 임신에서 저용량 아스피린: 최신 근거와 임상 적용

초록

Low-dose aspirin (LDA) has emerged as a cornerstone for the prevention of pre-eclampsia and related adverse outcomes in high-risk pregnancies. Multiple randomized controlled trials and meta-analyses, including the Aspirin for Evidence-Based Pre-eclampsia Prevention trial, have demonstrated that initiating LDA before 16 weeks of gestation, particularly at doses of 100 to 150 mg daily, significantly reduces the risk of preterm pre-eclampsia, fetal growth restriction, and perinatal morbidity. The primary mechanism involves inhibition of platelet thromboxane A₂ production while preserving prostacyclin synthesis, thereby improving uteroplacental blood flow. International guidelines, including those from American College of Obstetrics and Gynecology, National Institute for Health and Care Excellence, World Health Organization, and International Federation of Gynecology and Obstetrics, recommend LDA for women with specific high-risk factors such as a history of earlyonset pre-eclampsia, chronic hypertension, multifetal gestation, or autoimmune disorders. Currently, there are no national guidelines from the Korean Society of Obstetrics and Gynecology or other domestic professional bodies regarding aspirin prophylaxis in pregnancy, despite the prevalence of hypertensive disorders of pregnancy in Korea being approximately 3% to 5% of all pregnancies. This review summarizes the pharmacologic rationale, clinical trial evidence, safety profile, and interguideline differences, and proposes an evidence-based approach tailored to the Korean clinical setting.

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