Utilizing Thromboelastography to Assess the Efficacy and Safety of Aspirin in Preventing Pre-eclampsia

Utilizing Thromboelastography to Assess the Efficacy and Safety of Aspirin in Preventing Pre-eclampsia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Utilizing Thromboelastography to Assess the Efficacy and Safety of Aspirin in Preventing Pre-eclampsia Xue-hong ZHANG, Qiu-ling CHEN, Huanzhe Zhao, Jin-li Liu, Yong Liu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6929594/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Backgroud Pre-eclampsia (PE), a hypertensive disorder uniquely associated with human pregnancy, poses a significant risk to both maternal and fetal health. The prophylactic administration of aspirin has been widely acknowledged as a strategy to mitigate the incidence of pre-eclampsia. However, despite its global recognition, a consensus on the optimal methodology for evaluating the efficacy of aspirin in preventing pre-eclampsia remains elusive.This study investigate the Utility of Thromboelastography (TEG) in Assessing the Efficacy and Safety of Aspirin for Preventing PE by Analyzing TEG Parameters. Methods Maternal cases from a tertiary hospital in Shenzhen between January 1, 2019, and March 31, 2023, were selected for TEG assessment after 26 weeks of pregnancy. Outpatient and inpatient medical records, along with data from the Shenzhen Maternal and Child Health Care Management Information System, were retrospectively reviewed. Pregnant women were categorized into control (62 cases), risk (62 cases), and aspirin (50 cases) groups based on the presence of pre-eclampsia (PE) risk factors, aspirin prophylaxis, and discharge criteria. TEG parameters, platelet counts, and coagulation indexes were compared among the groups, and differences in each parameter were analyzed. Maternal and neonatal outcomes were also compared, assessing the efficacy and safety of aspirin. Factors influencing the occurrence of pre-eclampsia were determined using binary logistic regression analysis. Results Significant differences were observed in the incidence of pre-eclampsia (8.06%, 30.65%, 10.00%, P=0.001), cesarean section (58.06%, 79.03%, 76.00%, P=0.023), and preterm delivery (16.13%, 40.32%, 26.00%, P=0.010) among the three groups. TEG parameters, including R value (X 2 =12.977, P=0.011) and CI (X 2 =12.357, P=0.015), exhibited significant differences across the groups. Coagulation index TT values also significantly differed among the three groups (H=13.567, P=0.001). Multivariate analysis identified prophylactic aspirin use as a protective factor against pre-eclampsia development (OR 0.357, 95%CI 0.120-1.066). Conclusion This study demonstrates that low-dose aspirin effectively prevents pre-eclampsia in high-risk pregnancies without additional risks, while TEG proves valuable for monitoring aspirin's anticoagulant effects and guiding individualized treatment. thromboelastography pre-eclampsia aspirin coagulation indicators platelet Figures Figure 1 1. Background Pre-eclampsia is a progressive pregnancy-related disease characterized by hypertension and at least one other associated complication, including proteinuria, maternal organ dysfunction or uteroplacental dysfunction, manifesting after 20 weeks of gestation[ 1 ]. Pre-eclampsia is one of the leading causes of maternal and perinatal mortality and morbidity. It affects 2–5% of pregnancies, with an estimated annual global toll of around 76, 000 maternal deaths and 500, 000 neonatal deaths from pre-eclampsia, particularly pronounced in resource-limited low- and middle-income countries[ 2 ]. The etiology and pathophysiology of pre-eclampsia has not been fully elucidated. Current studies primarily suggest that abnormal vascular remodeling of the uterine spiral artery during early pregnancy and inadequate transformation capacity result in prolonged placental hypoperfusion[ 3 – 5 ]. The use of aspirin to prevent pre-eclampsia has long been proposed[ 6 ] and convincing evidence shows that low-dose aspirin from the first trimester reduces the risk of preterm pre-eclampsia [ 7 , 8 ]. The other reported treatments to prevent pre-eclampsia including calcium[ 9 ], low-molecular-weight heparin[ 10 ], and metformin[ 11 ], but further study is needed. Aspirin inhibits platelet activation and aggregation, vasoconstriction, and microthrombus formation, while promoting local blood circulation. These effects optimize uterine spiral artery remodelling and improve coagulation function[ 12 ], providing a theoretical basis for pre-eclampsia prevention. Since 1978, successful cases of aspirin preventing pre-eclampsia have been reported. Some studies have shown that prophylactic use of low-dose aspirin during pregnancy is safe[ 13 , 14 ]. However, other studies have shown that it increases the risk of postpartum hemorrhage[ 15 ]. WHO recommends the use of low-dose aspirin for pregnant women with moderate or high pre-eclampsia risk [ 16 ]. However, the consensus on the dose and duration of aspirin for pre-eclampsia prevention remains controversial in guidelines both domestically and internationally, and it is generally believed that pregnant women with high risk factors should take prophylactic aspirin at a dose of 50-162mg from before 12–16 weeks of pregnancy until 28 weeks of pregnancy[ 1 , 2 , 17 – 19 ]. Studies have shown that for women at high risk of pre-eclampsia, the time to discontinue aspirin may be when the sFlt: PIGF ratio returns to normal at 24–28 weeks of pregnancy[ 20 ]. However, there is no consensus on the optimal timing for initiating and discontinuing aspirin. Thromboelastography (TEG) simulates the dynamic changes of blood coagulation in vivo and in vitro, comprehensively analyzing the entire process from the initiation of the coagulation system, fibrin formation, platelet aggregation and adhesion, to platelet and fibrin bonding, blood clot formation, and dissolution. It is primarily used in perioperative surgery, hemophilia, Percutaneous Transluminal Coronary Intervention, sepsis, coagulation evaluation of cirrhosis, identification of ischemic stroke, pregnancy and postpartum hemorrhage, blood transfusion management, and other fields[ 21 ]. TEG parameters show characteristic alterations following aspirin administration, with these alterations potentially serving as predictors of aspirin's efficacy in prevention or treatment[ 22 , 23 ]. Some studies have highlighted TEG's particular relevance in obstetrics, where it has demonstrated value in predicting and managing pre-eclampsia[ 24 ]. However, it remains unclear whether TEG can predict the efficacy and safety of low-dose aspirin for prevention in this context. . The objective of this study is to investigate the clinical utility of TEG in evaluating the effectiveness and safety of aspirin for pre-eclampsia prevention through retrospective analysis. We aim to examine the association between TEG parameters and pregnancy outcomes in high-risk pregnancies, while generating new laboratory evidence regarding aspirin-induced coagulation changes during pregnancy. Ultimately, this research seeks to optimize aspirin prophylaxis protocols by providing objective data to guide clinical decision-making in pre-eclampsia prevention. 2. Methods 2. 1 Subjects This study adopts a retrospective observational design. 2.1.1 Data source: Maternal cases with complete TEG data after 26 weeks of pregnancy were retrospectively selected from a tertiary hospital in Shenzhen between January 1, 2019, and March 31, 2023. Pregnant women meeting the inclusion criteria were chosen as the subjects of observation. This study received approval from the Medical Ethics Committee of Shenzhen People's Hospital. (Ethical approval abtained: LL-KY-2023166-01) 2.1.2 Inclusion criteria: Pregnant women who were registered at the hospital between January 1, 2019, and March 31, 2023, and underwent TEG testing from 26 weeks of pregnancy until delivery. 2.1.3 Exclusion criteria: (1) Poor adherence or less than 4 weeks of aspirin use; (2) Incomplete medical records; (3) Patient's expressed intention to opt for abortion documented in the medical records. 2.2 Method 2.2.1 Patient enrollment and data collection: In accordance with the admission criteria, data were retrieved from the hospital examination system, and outpatient and inpatient medical records of pregnant women were retrospectively reviewed. Additionally, data from the Shenzhen Maternal and Child Health Care Management Information System were accessed. Relevant information, including age, height, weight, mode of conception, duration of pregnancy, delivery time, adverse pregnancy history, history of pre-eclampsia, TEG and coagulation function tests, was collected. Pregnancy outcomes, such as the occurrence of pre-eclampsia, gestational age at delivery, mode of delivery, amount of blood loss, neonatal weight, and Apgar score, were also recorded. TEG parameters change as the primary end point, blood coagulation function monitoring parameter change and pregnancy outcome and neonatal outcome for secondary end points. 2.2.2 Grouping: Based on the presence or absence of clinical risk factors for pre-eclampsia, as outlined in Table 1 [ 18 ], participants were categorized as follows: those without clinical risk factors comprised the control group; individuals with clinical risk factors but no use of aspirin constituted the risk group; and those with clinical risk factors who received continuous prophylactic aspirin at a dosage of 50–100 mg/day for a minimum of 4 weeks during pregnancy formed the aspirin group. Table 1 Clinical risk factors for pre-eclampsia Clinical Risk Factors:One High-Risk Factor Or Two Or More Moderate-Risk Factors High risk factor Moderate-risk factor 1. Chronic hypertension 2. Prior pre-eclampsia 3. Pre-pregnancy BMI>30kg/m 2 4. Gestational diabetes mellitus 5. Chronic kidney disease 6. Systemic lupus erythematosus 7. Antiphospholipid antibody syndrome 8. Assisted reproductive therapy 1. Prior placental abruption 2. Prior stillbirth 3. Prior fetal growth restriction 4. Maternal age>40 years 5. Nulliparity multifetal pregnancy BMI Body Mass Index 2.2.3 Thromboelastography (TEG) detection method Detecting instrument:Haemonetics Corporation TEG500 Blood specimen collection:Venous blood was drawn into a citrate anticoagulant vacuum collection tube (containing 3.2% sodium citrate) using a disposable vacuum blood collection device. Two tubes were collected, and the first tube was discarded. The mixture was gently inverted five times, and the test was completed within 2 hours. Blood sample detection:Remove the activated clotting reagent from the refrigerator and allow it to equilibrate at room temperature (15–30°C) for at least 15 minutes. Gently invert the reagent bottle to ensure thorough mixing, and let it settle at the bottom. After gently mixing the citrated whole blood sample 5 times, transfer 1 mL of the sample into the activated coagulation reagent bottle. Cover the reagent bottle and gently invert it 5 times to ensure proper mixing of the blood sample and reagent, then let it rest for 3–5 minutes. Prepare the sample cup by adding 20 µL of 0.2M calcium chloride. After gently mixing the activated coagulant vial 3 times, transfer 340 µL of the blood sample into the sample cup, and proceed with the test following the operating procedures of all testing instruments. 2.2.4. Platelet count and coagulation function test Detecting instrument:ALC-TOP, SysmexXN-9000 2. 3 Statistical Analysis Statistical analysis was performed using SPSS 23.0 software. Normality of the data was assessed using the Shapiro-Wilk test, and measurement data conforming to a normal distribution (P > 0.05) were presented as mean ± standard deviation (X ± S). Single-factor analysis of variance (ANOVA) was employed for comparing three groups of samples, with LSD test for between-group comparisons, and independent samples t-test for comparing two groups. Measurement data not conforming to normal distribution underwent Kruskal-Wallis test, and the results were reported as median (interquartile range) [M (P25, P75)]. Descriptive statistics included counts and percentages. Group comparisons were performed using the chi-square test, with statistical significance set at P < 0.05, the Bonferroni method was employed for post hoc comparisons between the two groups. Correlation analysis of the factors influencing pre-eclampsia was conducted using binary logistic regression analysis. 3. Result 3. 1 General condition of the study subjects Between January 1, 2019, and March 31, 2023, a tertiary hospital in Shenzhen City conducted TEG tests on 376 pregnant women. Among them, 202 cases were excluded, leaving 174 cases enrolled in the study. These included 62 cases in the control group, comprising individuals with clinical risk factors but no preventive use of aspirin (referred to as the risk group), and 50 cases in the group with clinical risk factors and preventive use of aspirin. Figure 1 . Age and BMI were significantly higher in the risk group and aspirin group compared to the control group (P 0.05). The most prevalent clinical risk factors included assisted reproductive therapy, gestational diabetes mellitus, and antiphospholipid antibody syndrome. There was no significant difference in the mean clinical risk factors between the risk and aspirin groups (P > 0.05). Table 2 . Table 2 Comparison Of The Maternal General Data Control Group (62 cases) Risk Group (62 cases) Aspirin Group (50 cases) F/X 2 /H P Maternal Age, Years 30.74 ± 4.281 *† 32.27 ± 4.216 * 33.04 ± 3.865 † 4.558 0.012 BMI(kg/m 2 ) 20.85(19.12、22.91) *† 22.33(20.02、25.20) * 22.47(20.42、23.66) † 7.468 0.024 Prior Pregnancy Time 2.00(1.00、3.00) 2.00(1.00、3.00) 2.00(1.00、3.00) 1.161 0.560 Prior Delivery Time 0(0、1.00) 0(0、1.00) 0(0、1.00) 2.707 0.258 High Risk Factor(Count) / 1.27 ± 0.548 1.30 ± 0.505 -0.256 0.798 Chronic hypertension / 4(6.45) 1(2.00) 0.454 0.500 BMI>30kg/m 2 / 5(8.16) 2(4.00) 0.241 0.624 Gestational Diabetes Mellitus / 30(48.39) 19(38.00) 1.213 0.271 Systemic Lupus Erythematosus / 4(6.45) 4(8.00) 0.100 0.752 Antiphospholipid Antibody Syndrome / 5(8.06) # 12(24.00) # 5.459 0.019 Assisted Reproductive Therapy / 30(48.39) # 30(60.00) # 3.968 0.046 Moderate-Risk Factor(Count) / 0.47 ± 0.593 0.44 ± 0.501 0.263 0.793 Prior Stillbirth / 23(37.10) 20(40.00) 0.099 0.753 Prior Fetal Growth Restriction / 1(1.62) 0(0) 1.000 0.554 Maternal Age>40 Years / 2(3.23) 0(0) 0.501 0.304 Nulliparity Multifetal Pregnancy / 3(4.84) 1(2.00) 0.086 0.770 TEG detection time(Week) 34.42 ± 4.43 33.98 ± 4.18 32.52 ± 4.06 3.507 0.032 BMI Body Mass Index * Significant difference between the control group and the risk group # Significant difference between the risk and aspirin group †Significant differences between the control group and aspirin group 3. 2 Maternal pregnancy outcomes and neonatal outcomes Table . The incidence of pre-eclampsia in the control, risk, and aspirin groups was 8.06%, 30.65%, and 10.00% (Table 3 ). Statistical differences were observed in the incidence of pre-eclampsia among the three groups. The incidence of pre-eclampsia was significantly higher in the risk group compared to the control group (P < 0.05), whereas it was significantly lower in the aspirin group (P < 0.05). However, there was no significant difference in the incidence of pre-eclampsia between the aspirin group and the control group. These findings imply that aspirin may substantially decrease the occurrence of pre-eclampsia among clinical risk factors women. The cesarean section rates in the control, risk, and aspirin groups were 58.06%, 79.03%, and 76.00%. However, the cesarean section rate was significantly higher in the gravid female with pre-eclampsia clinical risk factors, and aspirin had no impact on the cesarean section rate. There were significant differences in gestational weeks among the control group (38.04 ± 1.93), risk group (36.88 ± 2.52), and aspirin group (37.17 ± 2.08) (P < 0.05). Moreover, significant differences were noted in the preterm birth rate (gestational week < 37 w) between the control group and risk group, as well as between the risk group and aspirin group. The findings indicated a significant increase in the preterm birth rate among women with pre-eclampsia clinical risk factors, whereas aspirin intake was associated with a significant prolongation of pregnancy duration in these women without increasing the risk of preterm birth. No significant differences were observed in intrapartum hemorrhage, birth length, weight, or Apgar score among the control group, risk group, and aspirin group. 3. 3 TEG parameters and coagulation indicators outcomes As the reference ranges of TEG are poorly standardized[ 25 ] and the normal ranges of TEG in pregnancy varies in different studies[ 26 , 27 ], we still use the manufacturers’ reported reference ranges as cut off values to analysis the TEG tests. We found that the R time and CI were significantly among the three groups, and the other values showed no differences. The incidence of R < 5 min cases in the risk group was 20.97% higher than in the control group, while the proportion of R 3 in the risk group was 17.74% higher than in the control group, whereas CI > 3 in the aspirin group was 14.58% lower than in the control group. These results indicate a higher incidence of hypercoagulability in pregnancies at risk. However, after taking aspirin, blood hypercoagulability improves and approaches normal maternal levels. Table 4 . 3. 4 Platelet Count and Coagulation Indices We also analyzed the platelet count and coagulation function, and the results showed that there were no statistical differences in platelet count(PLT), activated partial thromboplastin time(APTT), prothrombin time(PT), fibrinogen(FIB) and international normalized ratio(INR), and there were statistical differences between thrombin time(TT), among which there were significant differences between control group and risk group, and between control group and aspirin group. These results indicate that the prolongation of TT in pregnant women with pre-eclampsia risk factors and the lack of improvement in preventive aspirin use may be related to the pathophysiological factors of the risk factors themselves, such as systemic lupus erythematosus. Table 5 . 3. 5 Risk Factor Analysis Of Pre-eclampsia Logistic univariate analysis revealed that BMI (OR 1.156, 95% CI 1.041–1.283), Clinical Risk Factors (OR 3.109, 95% CI 1.122–8.618), and APTT (OR 1.141, 95% CI 1.034–1.259) of pregnant women were risk factors for pre-eclampsia. Following correction by multivariate analysis, prophylactic aspirin use (OR 0.357, 95% CI 0.120–1.066) was negatively associated with pre-eclampsia (p = 0.065). No correlation was observed between TEG parameters and eclampsia. Table 6 . Table 3 Maternal and neonatal outcomes Control Group (62 Cases) Risk Group (62 Cases) Aspirin Group (50 Cases) F/X 2 /H p Maternal Outcomes Pre-eclampsia 5(8.06) * 19(30.65) *# 5(10.00) # 13.626 0.001 Cesarean Section 36(58.06) *† 49(79.03) * 38(76.00) † 7.533 0.023 Pregnant Weeks 38.04 ± 1.93 *† 36.88 ± 2.52 * 37.17 ± 2.08 † 4.665 0.011 Intrapartum Hemorrhage(mL) 339.35 ± 271.24 328.23 ± 200.61 282.80 ± 52.45 1.166 0.314 Neonatal Outcomes Premature Delivery (<37w) 10(16.13) * 25(40.32) * 13(26.00) 9.172 0.010 Birth Length(cm) 48.34 ± 3.58 47.05 ± 4.39 48.14 ± 2.75 2.160 0.118 Weight(g) 3020.16 ± 627.93 2755.48 ± 709.41 2913.70 ± 619.77 2.551 0.081 Apgar(1min) 10.00(10.00、10.00) 10.00(10.00、10.00) 10.00(10.00、10.00) 0.048 0.976 Apgar(5min) 10.00(10.00、10.00) 10.00(10.00、10.00) 10.00(10.00、10.00) 0.811 0.667 * Significant difference between the control group and the risk group # Significant difference between the risk and aspirin group †Significant differences between the control group and aspirin group Table 4 TEG parameters and coagulation indicators outcomes Control Group (62 cases) Risk Group (62 cases) Aspirin Group (50 cases) F/X 2 /H P R(min) R10 0(0) 0(0) 1(2.00) K(min) K3 1(1.61) 1(1.61) 0(0) Angle(°) Angle72 21(33.87) 23(37.10) 12(24.00) MA(min) MA70 26(41.94) 32(51.61) 21(42.00) LY30(%) 0.10(0.00、0.10) 0.10(0.10、0.10) 0.10(0.00、0.10) 6.224 0.055 EPL(%) 0.10(0.00、0.10) 0.10(0.10、0.10) 0.10(0.00、0.10) 4.612 0.100 G 11169.58 ± 2143.80 11799.43 ± 3107.44 11369.58 ± 3145.17 0.806 0.448 CI CI3 4(6.45) * 14(22.58) *# 4(8.00) # * Significant difference between the control group and the risk group # Significant difference between the risk group and aspirin group Table 5 Comparison Of Coagulation Function Control Group (62 cases) Risk Group (62 cases) Aspirin Group (50 cases) F/H P PLT(10^9/L) 204.68 ± 53.69 206.38 ± 56.01 227.16 ± 72.47 2.295 0.104 APTT(sec) 33.70(32.00、35.15) 33.58(31.18、35.15) 33.16(31.18、35.35) 1.070 0.586 PT(sec) 12.38(12.08、12.73) 12.40(12.20、12.70) 12.35(11.90、12.75) 1.136 0.567 TT(sec) 15.90(15.10、16.03) *† 16.30(15.80、16.63) * 16.40(15.50、17.00) † 13.567 0.001 FIB(g/L) 4.32(3.96、4.84) 4.23(3.88、4.77) 4.45(4.09、5.09) 2.382 0.304 INR 0.96(0.92、0.98) 0.94(0.92、0.96) 0.95(0.90、0.99) 2.650 0.266 * Significant difference between the control group and the risk group †Significant differences between the control group and aspirin group Table 6 analysis of factors influencing pre-eclampsia Pre-eclampsia Univariate Multivariate Yes (n = 29) No (n = 145) P OR(95%CI) P OR(95%CI) BMI 23.86 ± 4.45 21.84 ± 3.21 0.007 1.156(1.041–1.283) Clinical Risk Factors 24 5 0.029 3.109(1.122–8.618) 0.004 5.048(1.668–15.283) Aspirin 5 38 0.311 0.587(0.209–1.647) 0.065 0.357(0.120–1.066) CI CI3 8(27.59%) 16(11.03%) APTT 35.42 ± 3.15 33.19 ± 4.11 0.009 1.141(1.034–1.259) 0.006 1.160(1.044–1.290) TT 17.09 ± 1.58 16.15 ± 2.60 0.089 1.125(0.982–1.289) 4. Discussion This retrospective study demonstrated that prophylactic aspirin significantly reduces the incidence of pre-eclampsia and preterm birth in high-risk women without increasing cesarean delivery rates or neonatal complications. Importantly, TEG revealed that aspirin prolongs R time, lowers CI, and attenuates hypercoagulability, suggesting its utility in monitoring therapeutic efficacy. While TT was prolonged in high-risk pregnancies, aspirin did not further alter it, indicating its mechanism may be independent of thrombin-mediated pathways. These findings support aspirin's protective role while highlighting TEG as a potential tool for assessing treatment response in pre-eclampsia prevention. Aspirin's anti-inflammatory properties are hypothesized to enhance placentation, potentially mitigating the risk of pre-eclampsia. This hypothesis is substantiated by an expanding body of research, particularly among cohorts predisposed to pre-eclampsia[ 28 – 30 ]. International societies and organizational guidelines advocate for the efficacy of low-dose aspirin during pregnancy, typically ranging from 75 mg to 150 mg. Our study results demonstrated that prophylactic aspirin use significantly decreased the incidence of pre-eclampsia in clinical risk factors groud. Multivariate logistic analysis revealed that the presence of pre-eclampsia risk factors increased the incidence of pre-eclampsia by 5.048 times, whereas prophylactic aspirin use reduced the incidence by 0.357 times, consistent with the aforementioned findings. A recent multi-center RCT in China found no significant difference in the incidence of pre-eclampsia, adverse maternal and neonatal outcomes from the use of aspirin 100 mg daily from 12-20w to 34w of pregnancy[ 31 ], which may be related to different criteria for high risk factors. In this study, assisted reproduction, systemic lupus erythematosus, and antiphospholipid antibody syndrome were not included in the clinical risk factors, while in our study population, assisted reproduction (which has been listed as high risk factor in guidelines[ 18 ]) accounted for a relatively high proportion. Our study also observed a significantly higher cesarean section rate among pregnant women with clinical risk factors for pre-eclampsia compared to normal pregnant women (79.03% vs.58.06%), accompanied by a significantly shortened gestational period. Preventive aspirin use did not reduce the cesarean section rate (76.00% vs.79.07%), but was associated with prolonged gestational weeks. These findings are consistent with a large meta-analysis conducted by GanJie et al[ 32 ]. Prior meta-analyses have reported a reduction in preterm birth rates with the use of low-dose aspirin[ 33 , 34 ], but this has often been attributed to the concurrent reduction in preterm pre-eclampsia[ 15 , 28 ]. Numerous previous studies have demonstrated that prophylactic aspirin use does not elevate the risk of maternal and neonatal adverse events, such as bleeding, congenital malformation, and fetal growth restriction[ 35 ], a finding consistent with our results. However, a multi-center cohort study involving 6, 677 pregnant women who received prophylactic aspirin out of 71, 627 participants demonstrated that low-dose aspirin use during pregnancy was associated with increased postpartum bleeding [OR 1.21 (95% CI, 1.05–1.39)][ 36 ]. Notably, aspirin was primarily administered to patients aged ≥ 35 years and with a BMI ≥ 30 kg/m², differing from the characteristics of participants in our study. Studies have demonstrated that low-dose aspirin reduces the risk of fetal growth restriction [OR 0.80 (95% CI, 0.71–0.90)][ 34 ]. The results of this meta-analysis involved patients who initiated prophylactic aspirin use before 16 weeks gestation, a difference from our study. Therefore, the safety of aspirin should continue to be monitored when recommended for clinical risk pregnancies[ 35 ]. The coagulation function undergoes continuous changes throughout pregnancy, TEG can effectively monitor changes in coagulation function as well as changes in TEG associated with clinical risk factors throughout pregnancy. Lidan H et al. [ 37 ] found a significant reduction in the R value and a notable increase in the coagulation index CI in the pre-eclampsia group. Our results suggest that pregnant women with clinical risk factors for pre-eclampsia in the third trimester exhibit lower R values and higher CI values (the proportion of women with clinical risk factors having R 3 is significantly higher than that of healthy women), indicating a hypercoagulable state of the blood, which is consistent with previous findings. Furthermore, we observed significant changes in R values and CI values of clinical risk pregnant women after prophylactic aspirin use, suggesting that aspirin can effectively ameliorate hypercoagulability. This provides objective evidence for the efficacy of aspirin in preventing pre-eclampsia and underscores the utility of monitoring dynamic changes in TEG as a reference for aspirin administration. However, our logistic regression analysis revealed that R and CI values of TEG were not predictive of eclampsia occurrence or indicative of eclampsia risk factors. This could be attributed to variations in TEG changes at different stages of eclampsia progression, platelet and clotting factor consumption, among other factors. Additionally, the small sample size of eclampsia patients in our study precludes further analysis. In our analysis of routine coagulation function tests, we observed significant differences only in TT among all groups. The TT values of pregnant women with clinical risk factors were notably higher than those of normal pregnant women, potentially attributed to the long-term use of aspirin or low molecular weight heparin by pregnant women with systemic lupus and antiphospholipid antibody syndrome during pregnancy to mitigate the risk of blood hypercoagulation[ 38 ]. Aspirin has no effect on maternal TT, primarily because aspirin solely reduces thrombin production without impacting thrombin time[ 39 ]. This finding indicates that alterations in TEG are not aligned with changes in conventional coagulation markers in clinical risk women for pre-eclampsia. Additionally, multivariate analysis revealed that APTT was linked to pre-eclampsia development, with each 1-second prolongation of APTT increasing the risk of pre-eclampsia by 1.160-fold. Xu C et al. [ 40 , 41 ]also observed in their study that patients with pre-eclampsia exhibited prolonged APTT, consistent with the findings of our study. This may be related to the progressive consumption of blood clotting factors during the course of pre-eclampsia, which may contribute to hypocoagulability. 5. Conclusion This study confirms that low-dose aspirin (50-100mg/day) initiated at 16–28 weeks' gestation significantly prevents pre-eclampsia in high-risk women without increasing obstetric or neonatal risks. Importantly, TEG emerges as a clinically valuable tool for monitoring aspirin's anticoagulant effects, objectively guiding treatment by assessing hypercoagulability correction. These findings support TEG's potential role in optimizing aspirin prophylaxis for individualized pre-eclampsia prevention. Limitation This study had three important potential limitations. Firstly, the selection of clinical risk factors for pre-eclampsia recommended by ISSHP was adhered to, which may differ from those recommended by other guidelines. It is not feasible to include all potential risk factors in the study. For instance, multiple pregnancy was examined as one of the intermediate risk factors, whereas ACOG guidelines classify it as an independent risk factor. In this study, assisted reproduction and BMI > 30 are considered independent high-risk factors, whereas ACOG and NICE guidelines classify them as moderate-risk factors. Furthermore, regarding age, this study and ACOG classify age > 40 as an moderate-risk factors, while NICE considers age > 35 as an moderate-risk factors. Additionally, family history of pre-eclampsia was not included as a risk factor in the study, in contrast to ACOG and NICE guidelines. Secondly, in view of the retrospective design, TEG data were collected from 26 weeks of pregnancy until delivery. The extensive time span and variations in blood coagulation status across pregnancies, coupled with the small sample size, may introduce bias to the TEG data. Thirdly, considering postpartum hemorrhage as a potential complication of aspirin therapy, our study would benefit from a more comprehensive assessment. While we evaluated only postpartum blood loss, parameters such as postpartum hemoglobin levels, blood transfusion requirements, and 24-hour postpartum blood loss were not included, indicating a need for more thorough investigation in future studies. Despite these limitations, our study retrospectively provided valuable real-world data on the prophylactic use of aspirin in pregnant women with clinical risk factors for pre-eclampsia. Additionally, it further confirmed the efficacy and safety of aspirin in this population and offered guidance for interpreting TEG findings to assess aspirin's effect on coagulation function. However, further research is needed to validate these findings. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and was approved by the Medical Ethics Committee of Shenzhen People's Hospital, Retrospective study exempt informed consent.（Ethical approval abtained：LL-KY-2023166-01） Consent for publication All authors consent to publication. Data availability The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare no competing interests. Funding This work was supported by grants from the Shenzhen Science and Technology Program (Grant NOs JCYJ20220530152216036), the Shenzhen Key Medical Discipline Construction Fund (Grant No. SZXK059) and Shenzhen Key Laboratory of Prevention and Treatment of Severe Infections (ZDSYS20200811142804014). Author contributions Xue-hong ZHANG collected,analyzed the data, and drafted the manuscrept. Qiu-ling CHEN revised the manuscrept. Kuan LI designed the study, interpreted the data, and revised the manuscript. Huanzhe Zhao, Jin-li Liu , Yong Liu participated in data collation. All authors read and approved the final manuscript. Acknowledgements We would like to express our gratitude to all the teachers who provided assistance with this article. References [Diagnosis and treatment of hypertension. pre-eclampsia in pregnancy: a clinical practice guideline in China(2020)]. Zhonghua fu chan ke za zhi. 2020;55(4):227–38. The International Federation of Gynecology. and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first‐trimester screening and prevention. Int J Gynecol Obstet. 2019;145. Yuping W, Yang G, Yanping Z, David FL. Evidence of endothelial dysfunction in preeclampsia: decreased endothelial nitric oxide synthase expression is associated with increased cell permeability in endothelial cells from preeclampsia. Am J Obstet Gynecol. 2004;190(3). Anouk B, Mirjam vW, Ben Willem M, Christianne JM, dG. Preeclampsia; short and long-term consequences for mother and neonate. Early Hum Dev. 2016;102(0). Phipps E, Prasanna D, Brima W, Jim B. mini-review preeclampsia: updates in pathogenesis, definitions, and guidelines. 2018. Goodlin R, Haesslein H, Fleming J. Aspirin for the treatment of recurrent toxaemia. Lancet (London England). 1978;2(8079):51. Chappell L, Cluver C, Kingdom J, Tong S. Pre-eclampsia. Lancet (London England). 2021;398(10297):341–54. Evdokia D, Daniel LR, Wei Z, Guadalupe E-G, Kaori K, Rossana PVF et al. Pre-eclampsia. Nat Rev Dis Primers. 2023;9(1). Hofmeyr G, Lawrie T, Atallah Á, Torloni M. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2018;10(10):CD001059. Rodger M, Gris J, de Vries J, Martinelli I, Rey É, Schleussner E, et al. Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trials. Lancet (London England). 2016;388(10060):2629–41. Brownfoot F, Hastie R, Hannan N, Cannon P, Tuohey L, Parry L, et al. Metformin as a prevention and treatment for preeclampsia: effects on soluble fms-like tyrosine kinase 1 and soluble endoglin secretion and endothelial dysfunction. Am J Obstet Gynecol. 2016;214(3):356. .e1-.e15 . Loussert L, Vidal F, Parant O, Hamdi SM, Vayssiere C, Guerby P. Aspirin for prevention of preeclampsia and fetal growth restriction. Prenat Diagn. 2020;40. Roberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(2):110–. – 20.e6. Naimi A, Perkins N, Sjaarda L, Mumford S, Platt R, Silver R, et al. The Effect of Preconception-Initiated Low-Dose Aspirin on Human Chorionic Gonadotropin-Detected Pregnancy, Pregnancy Loss, and Live Birth: Per Protocol Analysis of a Randomized Trial. Ann Intern Med. 2021;174(5):595–601. Duley L, Meher S, Hunter K, Seidler A, Askie L. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2019;2019(10). WHO recommendations on. antiplatelet agents for the prevention of pre-eclampsia. 2021 2021. Gestational Hypertension and Preeclampsia. ACOG Practice Bulletin Summary, Number 222. Obstet Gynecol. 2020;135(6):1492–5. Magee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2022;27:148–69. Stefanovic V. International Academy of Perinatal Medicine (IAPM) guidelines for screening, prediction, prevention and management of pre-eclampsia to reduce maternal mortality in developing countries. J Perinat Med. 2023;51(2):164–9. Mendoza M, Bonacina E, Garcia-Manau P, López M, Caamiña S, Vives À, et al. Aspirin Discontinuation at 24 to 28 Weeks' Gestation in Pregnancies at High Risk of Preterm Preeclampsia: A Randomized Clinical Trial. JAMA. 2023;329(7):542–50. !!! INVALID CITATION !!! [20–27]. Guan J, Cong Y, Ren J, Zhu Y, Li L, Deng X, et al. Comparison between a new platelet count drop method PL-11, light transmission aggregometry, VerifyNow aspirin system and thromboelastography for monitoring short-term aspirin effects in healthy individuals. Platelets. 2015;26(1):25–30. Shao T, Cheng Y, Jin J, Huang L, Yang D, Luo C, et al. A comparison of three platelet function tests in ischemic stroke patients with antiplatelet therapy. J Clin neuroscience: official J Neurosurgical Soc Australasia. 2020;78:91–6. Man W, Zheng H, Qun XC, Jun X, Chao L. The ability of thromboelastography parameters to predict severe pre-eclampsia when measured during early pregnancy. Int J Gynaecol Obstet. 2019;145(2). Curry N, Davenport R, Pavord S, Mallett S, Kitchen D, Klein A, et al. The use of viscoelastic haemostatic assays in the management of major bleeding: A British Society for Haematology Guideline. Br J Haematol. 2018;182(6):789–806. Karlsson O, Sporrong T, Hillarp A, Jeppsson A, Hellgren M. Prospective longitudinal study of thromboelastography and standard hemostatic laboratory tests in healthy women during normal pregnancy. Anesth Analg. 2012;115(4):890–8. Shreeve N, Barry J, Deutsch L, Gomez K, Kadir R. Changes in thromboelastography parameters in pregnancy, labor, and the immediate postpartum period. Int J Gynaecol Obstet. 2016;134(3):290–3. Askie L, Duley L, Henderson-Smart D, Stewart L. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet (London England). 2007;369(9575):1791–8. Rolnik D, Wright D, Poon L, O'Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017;377(7):613–22. Liu F, Zhao M, Wang M, Yang H, Li L. Effect of regular oral intake of aspirin during pregnancy on pregnancy outcome of high-risk pregnancy-induced hypertension syndrome patients. Eur Rev Med Pharmacol Sci. 2016;20(23):5013–6. Lin L, Huai J, Li B, Zhu Y, Juan J, Zhang M, et al. A randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in women at high risk in China. Am J Obstet Gynecol. 2022;226(2):251. .e1-.e12 . Gan J, He H, Qi H. Preventing preeclampsia and its fetal complications with low-dose aspirin in East Asians and non-East Asians:A systematic review and meta-analysis. Hypertens Pregnancy. 2016;35(3):426–35. Henderson J, Vesco K, Senger C, Thomas R, Redmond N. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2021;326(12):1192–206. Xu T, Zhou F, Deng C, Huang G, Li J, Wang X. Low-Dose Aspirin for Preventing Preeclampsia and Its Complications: A Meta-Analysis. J Clin Hypertens (Greenwich Conn). 2015;17(7):567–73. Hoffman MK, Goudar SS, Kodkany BS, Metgud M, Wallace D. Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial. Lancet. 2020;395(10220):285–93. Souter V, Painter I, Sitcov K, Khalil A. Propensity score analysis of low-dose aspirin and bleeding complications in pregnancy. Ultrasound Obstet gynecology: official J Int Soc Ultrasound Obstet Gynecol. 2024;63(1):81–7. Lidan H, Jianbo W, Liqin G, Jifen H, Lin L, Xiuyan W. The Diagnostic Efficacy of Thrombelastography (TEG) in Patients with Preeclampsia and its Association with Blood Coagulation. Open life Sci. 2019;14:335–41. Kasitanon N, Hamijoyo L, Li M, Oku K, Navarra S, Tanaka Y, et al. Management of non-renal manifestations of systemic lupus erythematosus: A systematic literature review for the APLAR consensus statements. Int J Rheum Dis. 2022;25(11):1220–9. Szczeklik A, Krzanowski M, Góra P, Radwan J. Antiplatelet drugs and generation of thrombin in clotting blood. Blood. 1992;80(8):2006–11. Xu C, Li Y, Zhang W, Wang Q. Analysis of perinatal coagulation function in preeclampsia. Medicine. 2021;100(26):e26482. Shaheen G, Sajid S, Jahan S. Evaluation of coagulation factors and serum ferritin in preeclamptic Pakistani women. JPMA J Pakistan Med Association. 2020;70(11):2048–50. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6929594","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":489351567,"identity":"c4d9fa69-1968-49b7-9717-900f2f0633b9","order_by":0,"name":"Xue-hong ZHANG","email":"","orcid":"","institution":"Shantou University Medical College","correspondingAuthor":false,"prefix":"","firstName":"Xue-hong","middleName":"","lastName":"ZHANG","suffix":""},{"id":489351569,"identity":"f5d78051-7187-46fa-bb6c-61e1f8079f3d","order_by":1,"name":"Qiu-ling CHEN","email":"","orcid":"","institution":"Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University)","correspondingAuthor":false,"prefix":"","firstName":"Qiu-ling","middleName":"","lastName":"CHEN","suffix":""},{"id":489351571,"identity":"33dff8c3-7e3f-4905-aec7-07af1013cf2e","order_by":2,"name":"Huanzhe Zhao","email":"","orcid":"","institution":"Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University)","correspondingAuthor":false,"prefix":"","firstName":"Huanzhe","middleName":"","lastName":"Zhao","suffix":""},{"id":489351578,"identity":"3083c03e-7898-4b28-bf2f-e964df1d8b02","order_by":3,"name":"Jin-li Liu","email":"","orcid":"","institution":"The Fourth People's Hospital of Shenzhen (Shenzhen Sami Medical Center)","correspondingAuthor":false,"prefix":"","firstName":"Jin-li","middleName":"","lastName":"Liu","suffix":""},{"id":489351581,"identity":"5cb66dfb-55d3-44e5-8944-e68a672d448c","order_by":4,"name":"Yong Liu","email":"","orcid":"","institution":"The Fourth People's Hospital of Shenzhen (Shenzhen Sami Medical Center)","correspondingAuthor":false,"prefix":"","firstName":"Yong","middleName":"","lastName":"Liu","suffix":""},{"id":489351585,"identity":"6c173f0e-cdeb-4533-841c-4170eff90cfc","order_by":5,"name":"Kuan LI","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYBACPmYGZhDNw8/efPBBQoUNYS1sUC0ykj3Hkg0enEkjQgsDRIuNwY0cM8mHbYeI0MLOwGzMU3OHx+DMGbOKBLYDDPzt3QkEHZbMc+wZj+TxtrIbCTx3GCTOnN1AUMthHrbDPHxnDm+7kSDxjMFAIpcYLf8O8zDcSDArSDA4TJyWZN62wzwCN1LMGBISiNRiOLfvMA8okCUSDqTxEPQLP/8BZok33w7bg6Ly489/NnL87b34tQA1fUDh8hBQPgpGwSgYBaOAGAAAuAVDtoD5LtEAAAAASUVORK5CYII=","orcid":"","institution":"Shenzhen People's Hospital (The First Affiliated Hospital, Southern University of Science and Technology; The Second Clinical Medical College, Jinan University)","correspondingAuthor":true,"prefix":"","firstName":"Kuan","middleName":"","lastName":"LI","suffix":""}],"badges":[],"createdAt":"2025-06-19 09:23:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6929594/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6929594/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87666130,"identity":"97bcf1db-9a01-458c-a559-4ac04bcb4160","added_by":"auto","created_at":"2025-07-27 11:11:31","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65816,"visible":true,"origin":"","legend":"\u003cp\u003eThe Inclusion Of Subjects\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6929594/v1/2b3232370c8cdd363c4532d9.png"},{"id":91611401,"identity":"52f60e4d-edd7-4d24-bfa8-53c818d2377c","added_by":"auto","created_at":"2025-09-18 09:55:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1108377,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6929594/v1/13005293-b24d-4ca9-900d-bb4934399fd8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Utilizing Thromboelastography to Assess the Efficacy and Safety of Aspirin in Preventing Pre-eclampsia","fulltext":[{"header":"1. Background","content":"\u003cp\u003ePre-eclampsia is a progressive pregnancy-related disease characterized by hypertension and at least one other associated complication, including proteinuria, maternal organ dysfunction or uteroplacental dysfunction, manifesting after 20 weeks of gestation[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Pre-eclampsia is one of the leading causes of maternal and perinatal mortality and morbidity. It affects 2\u0026ndash;5% of pregnancies, with an estimated annual global toll of around 76, 000 maternal deaths and 500, 000 neonatal deaths from pre-eclampsia, particularly pronounced in resource-limited low- and middle-income countries[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The etiology and pathophysiology of pre-eclampsia has not been fully elucidated. Current studies primarily suggest that abnormal vascular remodeling of the uterine spiral artery during early pregnancy and inadequate transformation capacity result in prolonged placental hypoperfusion[\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The use of aspirin to prevent pre-eclampsia has long been proposed[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and convincing evidence shows that low-dose aspirin from the first trimester reduces the risk of preterm pre-eclampsia [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The other reported treatments to prevent pre-eclampsia including calcium[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], low-molecular-weight heparin[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and metformin[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], but further study is needed.\u003c/p\u003e\u003cp\u003eAspirin inhibits platelet activation and aggregation, vasoconstriction, and microthrombus formation, while promoting local blood circulation. These effects optimize uterine spiral artery remodelling and improve coagulation function[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], providing a theoretical basis for pre-eclampsia prevention. Since 1978, successful cases of aspirin preventing pre-eclampsia have been reported. Some studies have shown that prophylactic use of low-dose aspirin during pregnancy is safe[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, other studies have shown that it increases the risk of postpartum hemorrhage[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. WHO recommends the use of low-dose aspirin for pregnant women with moderate or high pre-eclampsia risk [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, the consensus on the dose and duration of aspirin for pre-eclampsia prevention remains controversial in guidelines both domestically and internationally, and it is generally believed that pregnant women with high risk factors should take prophylactic aspirin at a dose of 50-162mg from before 12\u0026ndash;16 weeks of pregnancy until 28 weeks of pregnancy[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Studies have shown that for women at high risk of pre-eclampsia, the time to discontinue aspirin may be when the sFlt: PIGF ratio returns to normal at 24\u0026ndash;28 weeks of pregnancy[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, there is no consensus on the optimal timing for initiating and discontinuing aspirin.\u003c/p\u003e\u003cp\u003eThromboelastography (TEG) simulates the dynamic changes of blood coagulation in vivo and in vitro, comprehensively analyzing the entire process from the initiation of the coagulation system, fibrin formation, platelet aggregation and adhesion, to platelet and fibrin bonding, blood clot formation, and dissolution. It is primarily used in perioperative surgery, hemophilia, Percutaneous Transluminal Coronary Intervention, sepsis, coagulation evaluation of cirrhosis, identification of ischemic stroke, pregnancy and postpartum hemorrhage, blood transfusion management, and other fields[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. TEG parameters show characteristic alterations following aspirin administration, with these alterations potentially serving as predictors of aspirin's efficacy in prevention or treatment[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Some studies have highlighted TEG's particular relevance in obstetrics, where it has demonstrated value in predicting and managing pre-eclampsia[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, it remains unclear whether TEG can predict the efficacy and safety of low-dose aspirin for prevention in this context. .\u003c/p\u003e\u003cp\u003eThe objective of this study is to investigate the clinical utility of TEG in evaluating the effectiveness and safety of aspirin for pre-eclampsia prevention through retrospective analysis. We aim to examine the association between TEG parameters and pregnancy outcomes in high-risk pregnancies, while generating new laboratory evidence regarding aspirin-induced coagulation changes during pregnancy. Ultimately, this research seeks to optimize aspirin prophylaxis protocols by providing objective data to guide clinical decision-making in pre-eclampsia prevention.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003ch3\u003e2. 1 Subjects\u003c/h3\u003e\n\u003cp\u003eThis study adopts a retrospective observational design.\u003c/p\u003e\n\u003cp\u003e2.1.1 Data source: Maternal cases with complete TEG data after 26 weeks of pregnancy were retrospectively selected from a tertiary hospital in Shenzhen between January 1, 2019, and March 31, 2023. Pregnant women meeting the inclusion criteria were chosen as the subjects of observation. This study received approval from the Medical Ethics Committee of Shenzhen People\u0026apos;s Hospital. (Ethical approval abtained: LL-KY-2023166-01)\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e2.1.2 Inclusion criteria: Pregnant women who were registered at the hospital between January 1, 2019, and March 31, 2023, and underwent TEG testing from 26 weeks of pregnancy until delivery.\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e2.1.3 Exclusion criteria: (1) Poor adherence or less than 4 weeks of aspirin use; (2) Incomplete medical records; (3) Patient\u0026apos;s expressed intention to opt for abortion documented in the medical records.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Method\u003c/h2\u003e\u003cspan\u003e\n \u003cp\u003e2.2.1 Patient enrollment and data collection: In accordance with the admission criteria, data were retrieved from the hospital examination system, and outpatient and inpatient medical records of pregnant women were retrospectively reviewed. Additionally, data from the Shenzhen Maternal and Child Health Care Management Information System were accessed. Relevant information, including age, height, weight, mode of conception, duration of pregnancy, delivery time, adverse pregnancy history, history of pre-eclampsia, TEG and coagulation function tests, was collected. Pregnancy outcomes, such as the occurrence of pre-eclampsia, gestational age at delivery, mode of delivery, amount of blood loss, neonatal weight, and Apgar score, were also recorded. TEG parameters change as the primary end point, blood coagulation function monitoring parameter change and pregnancy outcome and neonatal outcome for secondary end points.\u003c/p\u003e\n \u003c/span\u003e\u003cspan\u003e\n \u003cp\u003e2.2.2 Grouping: Based on the presence or absence of clinical risk factors for pre-eclampsia, as outlined in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e[\u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e], participants were categorized as follows: those without clinical risk factors comprised the control group; individuals with clinical risk factors but no use of aspirin constituted the risk group; and those with clinical risk factors who received continuous prophylactic aspirin at a dosage of 50\u0026ndash;100 mg/day for a minimum of 4 weeks during pregnancy formed the aspirin group.\u003c/p\u003e\n \u003c/span\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinical risk factors for pre-eclampsia\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eClinical Risk Factors:One High-Risk Factor Or Two Or More Moderate-Risk Factors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh risk factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eModerate-risk factor\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Chronic hypertension\u003c/p\u003e\n \u003cp\u003e2. Prior pre-eclampsia\u003c/p\u003e\n \u003cp\u003e3. Pre-pregnancy BMI\u0026gt;30kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003e4. Gestational diabetes mellitus\u003c/p\u003e\n \u003cp\u003e5. Chronic kidney disease\u003c/p\u003e\n \u003cp\u003e6. Systemic lupus erythematosus\u003c/p\u003e\n \u003cp\u003e7. Antiphospholipid antibody syndrome\u003c/p\u003e\n \u003cp\u003e8. Assisted reproductive therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1. Prior placental abruption\u003c/p\u003e\n \u003cp\u003e2. Prior stillbirth\u003c/p\u003e\n \u003cp\u003e3. Prior fetal growth restriction\u003c/p\u003e\n \u003cp\u003e4. Maternal age\u0026gt;40 years\u003c/p\u003e\n \u003cp\u003e5. Nulliparity multifetal pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003eBMI Body Mass Index\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.3 Thromboelastography (TEG) detection method\u003c/h2\u003e\n \u003cp\u003eDetecting instrument:Haemonetics Corporation TEG500\u003c/p\u003e\n \u003cp\u003eBlood specimen collection:Venous blood was drawn into a citrate anticoagulant vacuum collection tube (containing 3.2% sodium citrate) using a disposable vacuum blood collection device. Two tubes were collected, and the first tube was discarded. The mixture was gently inverted five times, and the test was completed within 2 hours.\u003c/p\u003e\n \u003cp\u003eBlood sample detection:Remove the activated clotting reagent from the refrigerator and allow it to equilibrate at room temperature (15\u0026ndash;30\u0026deg;C) for at least 15 minutes. Gently invert the reagent bottle to ensure thorough mixing, and let it settle at the bottom. After gently mixing the citrated whole blood sample 5 times, transfer 1 mL of the sample into the activated coagulation reagent bottle. Cover the reagent bottle and gently invert it 5 times to ensure proper mixing of the blood sample and reagent, then let it rest for 3\u0026ndash;5 minutes. Prepare the sample cup by adding 20 \u0026micro;L of 0.2M calcium chloride. After gently mixing the activated coagulant vial 3 times, transfer 340 \u0026micro;L of the blood sample into the sample cup, and proceed with the test following the operating procedures of all testing instruments.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003e2.2.4. Platelet count and coagulation function test\u003c/h2\u003e\n \u003cp\u003eDetecting instrument:ALC-TOP, SysmexXN-9000\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003ch3\u003e2. 3 Statistical Analysis\u003c/h3\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS 23.0 software. Normality of the data was assessed using the Shapiro-Wilk test, and measurement data conforming to a normal distribution (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) were presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (X\u0026thinsp;\u0026plusmn;\u0026thinsp;S). Single-factor analysis of variance (ANOVA) was employed for comparing three groups of samples, with LSD test for between-group comparisons, and independent samples t-test for comparing two groups. Measurement data not conforming to normal distribution underwent Kruskal-Wallis test, and the results were reported as median (interquartile range) [M (P25, P75)]. Descriptive statistics included counts and percentages. Group comparisons were performed using the chi-square test, with statistical significance set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, the Bonferroni method was employed for post hoc comparisons between the two groups. Correlation analysis of the factors influencing pre-eclampsia was conducted using binary logistic regression analysis.\u003c/p\u003e"},{"header":"3. Result","content":"\n\u003ch3\u003e3. 1 General condition of the study subjects\u003c/h3\u003e\n\u003cp\u003eBetween January 1, 2019, and March 31, 2023, a tertiary hospital in Shenzhen City conducted TEG tests on 376 pregnant women. Among them, 202 cases were excluded, leaving 174 cases enrolled in the study. These included 62 cases in the control group, comprising individuals with clinical risk factors but no preventive use of aspirin (referred to as the risk group), and 50 cases in the group with clinical risk factors and preventive use of aspirin. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eAge and BMI were significantly higher in the risk group and aspirin group compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). There was no significant difference in the TEG detection time, pregnancy and delivery times among the there group (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The most prevalent clinical risk factors included assisted reproductive therapy, gestational diabetes mellitus, and antiphospholipid antibody syndrome. There was no significant difference in the mean clinical risk factors between the risk and aspirin groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison Of The Maternal General Data\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(62 cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRisk Group\u003c/p\u003e\u003cp\u003e(62 cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAspirin Group\u003c/p\u003e\u003cp\u003e(50 cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF/X\u003csup\u003e2\u003c/sup\u003e/H\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal Age, Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.74\u0026thinsp;\u0026plusmn;\u0026thinsp;4.281\u003csup\u003e*\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.216\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.04\u0026thinsp;\u0026plusmn;\u0026thinsp;3.865\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.558\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI(kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20.85(19.12、22.91)\u003csup\u003e*\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22.33(20.02、25.20)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.47(20.42、23.66)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7.468\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior Pregnancy Time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.00(1.00、3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.00(1.00、3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.00(1.00、3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.560\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior Delivery Time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0、1.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0、1.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0、1.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.707\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.258\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh Risk Factor(Count)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.27\u0026thinsp;\u0026plusmn;\u0026thinsp;0.548\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.30\u0026thinsp;\u0026plusmn;\u0026thinsp;0.505\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChronic hypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(6.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.454\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.500\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u0026gt;30kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(8.16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2(4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.241\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.624\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGestational Diabetes Mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(48.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19(38.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.213\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.271\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSystemic Lupus Erythematosus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(6.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(8.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.752\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntiphospholipid Antibody Syndrome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5(8.06)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(24.00)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.459\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.019\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAssisted Reproductive Therapy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30(48.39)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30(60.00)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.968\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModerate-Risk Factor(Count)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.593\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.44\u0026thinsp;\u0026plusmn;\u0026thinsp;0.501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.263\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.793\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior Stillbirth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(37.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20(40.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.753\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrior Fetal Growth Restriction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.554\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaternal Age\u0026gt;40 Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2(3.23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.501\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.304\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNulliparity Multifetal Pregnancy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e/\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3(4.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.086\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.770\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTEG detection time(Week)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e32.52\u0026thinsp;\u0026plusmn;\u0026thinsp;4.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.507\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003eBMI Body Mass Index\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Significant difference between the control group and the risk group\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e# Significant difference between the risk and aspirin group\u003c/p\u003e\u003cp\u003e\u0026dagger;Significant differences between the control group and aspirin group\u003c/p\u003e\n\u003ch3\u003e3. 2 Maternal pregnancy outcomes and neonatal outcomes Table .\u003c/h3\u003e\n\u003cp\u003eThe incidence of pre-eclampsia in the control, risk, and aspirin groups was 8.06%, 30.65%, and 10.00% (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Statistical differences were observed in the incidence of pre-eclampsia among the three groups. The incidence of pre-eclampsia was significantly higher in the risk group compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), whereas it was significantly lower in the aspirin group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, there was no significant difference in the incidence of pre-eclampsia between the aspirin group and the control group. These findings imply that aspirin may substantially decrease the occurrence of pre-eclampsia among clinical risk factors women.\u003c/p\u003e\u003cp\u003eThe cesarean section rates in the control, risk, and aspirin groups were 58.06%, 79.03%, and 76.00%. However, the cesarean section rate was significantly higher in the gravid female with pre-eclampsia clinical risk factors, and aspirin had no impact on the cesarean section rate.\u003c/p\u003e\u003cp\u003eThere were significant differences in gestational weeks among the control group (38.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93), risk group (36.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52), and aspirin group (37.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Moreover, significant differences were noted in the preterm birth rate (gestational week\u0026thinsp;\u0026lt;\u0026thinsp;37 w) between the control group and risk group, as well as between the risk group and aspirin group. The findings indicated a significant increase in the preterm birth rate among women with pre-eclampsia clinical risk factors, whereas aspirin intake was associated with a significant prolongation of pregnancy duration in these women without increasing the risk of preterm birth.\u003c/p\u003e\u003cp\u003eNo significant differences were observed in intrapartum hemorrhage, birth length, weight, or Apgar score among the control group, risk group, and aspirin group.\u003c/p\u003e\n\u003ch3\u003e3. 3 TEG parameters and coagulation indicators outcomes\u003c/h3\u003e\n\u003cp\u003eAs the reference ranges of TEG are poorly standardized[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and the normal ranges of TEG in pregnancy varies in different studies[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], we still use the manufacturers\u0026rsquo; reported reference ranges as cut off values to analysis the TEG tests. We found that the R time and CI were significantly among the three groups, and the other values showed no differences. The incidence of R\u0026thinsp;\u0026lt;\u0026thinsp;5 min cases in the risk group was 20.97% higher than in the control group, while the proportion of R\u0026thinsp;\u0026lt;\u0026thinsp;5 min cases in the aspirin group was 25.10% lower than in the control group. Regarding CI, the occurrence of CI\u0026thinsp;\u0026gt;\u0026thinsp;3 in the risk group was 17.74% higher than in the control group, whereas CI\u0026thinsp;\u0026gt;\u0026thinsp;3 in the aspirin group was 14.58% lower than in the control group. These results indicate a higher incidence of hypercoagulability in pregnancies at risk. However, after taking aspirin, blood hypercoagulability improves and approaches normal maternal levels. Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003e3. 4 Platelet Count and Coagulation Indices\u003c/h3\u003e\n\u003cp\u003eWe also analyzed the platelet count and coagulation function, and the results showed that there were no statistical differences in platelet count(PLT), activated partial thromboplastin time(APTT), prothrombin time(PT), fibrinogen(FIB) and international normalized ratio(INR), and there were statistical differences between thrombin time(TT), among which there were significant differences between control group and risk group, and between control group and aspirin group. These results indicate that the prolongation of TT in pregnant women with pre-eclampsia risk factors and the lack of improvement in preventive aspirin use may be related to the pathophysiological factors of the risk factors themselves, such as systemic lupus erythematosus. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003ch3\u003e3. 5 Risk Factor Analysis Of Pre-eclampsia\u003c/h3\u003e\n\u003cp\u003eLogistic univariate analysis revealed that BMI (OR 1.156, 95% CI 1.041\u0026ndash;1.283), Clinical Risk Factors (OR 3.109, 95% CI 1.122\u0026ndash;8.618), and APTT (OR 1.141, 95% CI 1.034\u0026ndash;1.259) of pregnant women were risk factors for pre-eclampsia. Following correction by multivariate analysis, prophylactic aspirin use (OR 0.357, 95% CI 0.120\u0026ndash;1.066) was negatively associated with pre-eclampsia (p\u0026thinsp;=\u0026thinsp;0.065). No correlation was observed between TEG parameters and eclampsia. Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal and neonatal outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(62 Cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRisk Group\u003c/p\u003e\u003cp\u003e(62 Cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAspirin Group\u003c/p\u003e\u003cp\u003e(50 Cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF/X\u003csup\u003e2\u003c/sup\u003e/H\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eMaternal Outcomes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-eclampsia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(8.06)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19(30.65)\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(10.00)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.626\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCesarean Section\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36(58.06)\u003csup\u003e*\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49(79.03)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38(76.00)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e7.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePregnant Weeks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003csup\u003e*\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.88\u0026thinsp;\u0026plusmn;\u0026thinsp;2.52\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.17\u0026thinsp;\u0026plusmn;\u0026thinsp;2.08\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.665\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntrapartum Hemorrhage(mL)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e339.35\u0026thinsp;\u0026plusmn;\u0026thinsp;271.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e328.23\u0026thinsp;\u0026plusmn;\u0026thinsp;200.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e282.80\u0026thinsp;\u0026plusmn;\u0026thinsp;52.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.314\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eNeonatal Outcomes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePremature Delivery\u003c/p\u003e\u003cp\u003e(\u0026lt;37w)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10(16.13)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25(40.32)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13(26.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9.172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBirth Length(cm)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48.34\u0026thinsp;\u0026plusmn;\u0026thinsp;3.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47.05\u0026thinsp;\u0026plusmn;\u0026thinsp;4.39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48.14\u0026thinsp;\u0026plusmn;\u0026thinsp;2.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.160\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.118\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeight(g)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3020.16\u0026thinsp;\u0026plusmn;\u0026thinsp;627.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2755.48\u0026thinsp;\u0026plusmn;\u0026thinsp;709.41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2913.70\u0026thinsp;\u0026plusmn;\u0026thinsp;619.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.551\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.081\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApgar(1min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.00(10.00、10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.00(10.00、10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.00(10.00、10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.048\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.976\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eApgar(5min)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.00(10.00、10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.00(10.00、10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.00(10.00、10.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.811\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.667\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Significant difference between the control group and the risk group\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e# Significant difference between the risk and aspirin group\u003c/p\u003e\u003cp\u003e\u0026dagger;Significant differences between the control group and aspirin group\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTEG parameters and coagulation indicators outcomes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(62 cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRisk Group\u003c/p\u003e\u003cp\u003e(62 cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAspirin Group\u003c/p\u003e\u003cp\u003e(50 cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF/X\u003csup\u003e2\u003c/sup\u003e/H\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eR(min)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR\u0026lt;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11(17.74)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(37.10)\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(12.00)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e13.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u0026thinsp;\u0026le;\u0026thinsp;R\u0026thinsp;\u0026le;\u0026thinsp;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51(82.26)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39(62.90)\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43(86.00)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eR\u0026gt;10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(2.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eK(min)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK\u0026lt;1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5(8.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11(17.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6(12.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3.489\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.480\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u0026thinsp;\u0026le;\u0026thinsp;K\u0026thinsp;\u0026le;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56(90.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50(80.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44(88.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eK\u0026gt;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1(1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eAngle(\u0026deg;)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAngle\u0026lt;53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1(2.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3.378\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.497\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e53\u0026thinsp;\u0026le;\u0026thinsp;Angle\u0026thinsp;\u0026le;\u0026thinsp;72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41(66.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38(61.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37(74.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAngle\u0026gt;72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21(33.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23(37.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12(24.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eMA(min)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMA\u0026lt;50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3.562\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.469\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e50\u0026thinsp;\u0026le;\u0026thinsp;MA\u0026thinsp;\u0026le;\u0026thinsp;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36(58.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29(46.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29(58.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMA\u0026gt;70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26(41.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32(51.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21(42.00)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLY30(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.10(0.00、0.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.10(0.10、0.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.10(0.00、0.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.224\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.055\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEPL(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.10(0.00、0.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.10(0.10、0.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.10(0.00、0.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.612\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eG\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11169.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2143.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11799.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3107.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11369.58\u0026thinsp;\u0026plusmn;\u0026thinsp;3145.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.806\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.448\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eCI\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCI\u0026lt;-3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1(1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0(0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e10.726\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e-3\u0026thinsp;\u0026le;\u0026thinsp;CI\u0026thinsp;\u0026le;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58(93.55)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47(75.81)\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46(92.00)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCI\u0026gt;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4(6.45)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14(22.58)\u003csup\u003e*#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(8.00)\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Significant difference between the control group and the risk group\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e# Significant difference between the risk group and aspirin group\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison Of Coagulation Function\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003cp\u003e(62 cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRisk Group\u003c/p\u003e\u003cp\u003e(62 cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAspirin Group\u003c/p\u003e\u003cp\u003e(50 cases)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eF/H\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePLT(10^9/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e204.68\u0026thinsp;\u0026plusmn;\u0026thinsp;53.69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e206.38\u0026thinsp;\u0026plusmn;\u0026thinsp;56.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e227.16\u0026thinsp;\u0026plusmn;\u0026thinsp;72.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.295\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.104\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPTT(sec)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e33.70(32.00、35.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.58(31.18、35.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33.16(31.18、35.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.070\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.586\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePT(sec)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.38(12.08、12.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.40(12.20、12.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.35(11.90、12.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.567\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTT(sec)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.90(15.10、16.03)\u003csup\u003e*\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.30(15.80、16.63)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.40(15.50、17.00)\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e13.567\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFIB(g/L)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.32(3.96、4.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.23(3.88、4.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.45(4.09、5.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.382\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.304\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eINR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.96(0.92、0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.94(0.92、0.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.95(0.90、0.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.650\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.266\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e* Significant difference between the control group and the risk group\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u0026dagger;Significant differences between the control group and aspirin group\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eanalysis of factors influencing pre-eclampsia\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePre-eclampsia\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eUnivariate\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eMultivariate\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;145)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eOR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOR(95%CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23.86\u0026thinsp;\u0026plusmn;\u0026thinsp;4.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.84\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.156(1.041\u0026ndash;1.283)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Risk Factors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.109(1.122\u0026ndash;8.618)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.048(1.668\u0026ndash;15.283)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAspirin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.587(0.209\u0026ndash;1.647)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.357(0.120\u0026ndash;1.066)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003eCI\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCI\u0026lt;-3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.075\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e2.426(0.913\u0026ndash;6.444)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e-3\u0026thinsp;\u0026le;\u0026thinsp;C\u0026thinsp;\u0026le;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e129\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCI\u0026gt;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(27.59%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(11.03%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAPTT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35.42\u0026thinsp;\u0026plusmn;\u0026thinsp;3.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.19\u0026thinsp;\u0026plusmn;\u0026thinsp;4.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.141(1.034\u0026ndash;1.259)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.160(1.044\u0026ndash;1.290)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTT\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.125(0.982\u0026ndash;1.289)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis retrospective study demonstrated that prophylactic aspirin significantly reduces the incidence of pre-eclampsia and preterm birth in high-risk women without increasing cesarean delivery rates or neonatal complications. Importantly, TEG revealed that aspirin prolongs R time, lowers CI, and attenuates hypercoagulability, suggesting its utility in monitoring therapeutic efficacy. While TT was prolonged in high-risk pregnancies, aspirin did not further alter it, indicating its mechanism may be independent of thrombin-mediated pathways. These findings support aspirin's protective role while highlighting TEG as a potential tool for assessing treatment response in pre-eclampsia prevention.\u003c/p\u003e\u003cp\u003eAspirin's anti-inflammatory properties are hypothesized to enhance placentation, potentially mitigating the risk of pre-eclampsia. This hypothesis is substantiated by an expanding body of research, particularly among cohorts predisposed to pre-eclampsia[\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. International societies and organizational guidelines advocate for the efficacy of low-dose aspirin during pregnancy, typically ranging from 75 mg to 150 mg. Our study results demonstrated that prophylactic aspirin use significantly decreased the incidence of pre-eclampsia in clinical risk factors groud. Multivariate logistic analysis revealed that the presence of pre-eclampsia risk factors increased the incidence of pre-eclampsia by 5.048 times, whereas prophylactic aspirin use reduced the incidence by 0.357 times, consistent with the aforementioned findings. A recent multi-center RCT in China found no significant difference in the incidence of pre-eclampsia, adverse maternal and neonatal outcomes from the use of aspirin 100 mg daily from 12-20w to 34w of pregnancy[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], which may be related to different criteria for high risk factors. In this study, assisted reproduction, systemic lupus erythematosus, and antiphospholipid antibody syndrome were not included in the clinical risk factors, while in our study population, assisted reproduction (which has been listed as high risk factor in guidelines[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]) accounted for a relatively high proportion. Our study also observed a significantly higher cesarean section rate among pregnant women with clinical risk factors for pre-eclampsia compared to normal pregnant women (79.03% vs.58.06%), accompanied by a significantly shortened gestational period. Preventive aspirin use did not reduce the cesarean section rate (76.00% vs.79.07%), but was associated with prolonged gestational weeks. These findings are consistent with a large meta-analysis conducted by GanJie et al[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Prior meta-analyses have reported a reduction in preterm birth rates with the use of low-dose aspirin[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], but this has often been attributed to the concurrent reduction in preterm pre-eclampsia[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eNumerous previous studies have demonstrated that prophylactic aspirin use does not elevate the risk of maternal and neonatal adverse events, such as bleeding, congenital malformation, and fetal growth restriction[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], a finding consistent with our results. However, a multi-center cohort study involving 6, 677 pregnant women who received prophylactic aspirin out of 71, 627 participants demonstrated that low-dose aspirin use during pregnancy was associated with increased postpartum bleeding [OR 1.21 (95% CI, 1.05\u0026ndash;1.39)][\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Notably, aspirin was primarily administered to patients aged\u0026thinsp;\u0026ge;\u0026thinsp;35 years and with a BMI\u0026thinsp;\u0026ge;\u0026thinsp;30 kg/m\u0026sup2;, differing from the characteristics of participants in our study. Studies have demonstrated that low-dose aspirin reduces the risk of fetal growth restriction [OR 0.80 (95% CI, 0.71\u0026ndash;0.90)][\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The results of this meta-analysis involved patients who initiated prophylactic aspirin use before 16 weeks gestation, a difference from our study. Therefore, the safety of aspirin should continue to be monitored when recommended for clinical risk pregnancies[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe coagulation function undergoes continuous changes throughout pregnancy, TEG can effectively monitor changes in coagulation function as well as changes in TEG associated with clinical risk factors throughout pregnancy. Lidan H et al. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] found a significant reduction in the R value and a notable increase in the coagulation index CI in the pre-eclampsia group. Our results suggest that pregnant women with clinical risk factors for pre-eclampsia in the third trimester exhibit lower R values and higher CI values (the proportion of women with clinical risk factors having R\u0026thinsp;\u0026lt;\u0026thinsp;5 and CI\u0026thinsp;\u0026gt;\u0026thinsp;3 is significantly higher than that of healthy women), indicating a hypercoagulable state of the blood, which is consistent with previous findings. Furthermore, we observed significant changes in R values and CI values of clinical risk pregnant women after prophylactic aspirin use, suggesting that aspirin can effectively ameliorate hypercoagulability. This provides objective evidence for the efficacy of aspirin in preventing pre-eclampsia and underscores the utility of monitoring dynamic changes in TEG as a reference for aspirin administration. However, our logistic regression analysis revealed that R and CI values of TEG were not predictive of eclampsia occurrence or indicative of eclampsia risk factors. This could be attributed to variations in TEG changes at different stages of eclampsia progression, platelet and clotting factor consumption, among other factors. Additionally, the small sample size of eclampsia patients in our study precludes further analysis.\u003c/p\u003e\u003cp\u003eIn our analysis of routine coagulation function tests, we observed significant differences only in TT among all groups. The TT values of pregnant women with clinical risk factors were notably higher than those of normal pregnant women, potentially attributed to the long-term use of aspirin or low molecular weight heparin by pregnant women with systemic lupus and antiphospholipid antibody syndrome during pregnancy to mitigate the risk of blood hypercoagulation[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Aspirin has no effect on maternal TT, primarily because aspirin solely reduces thrombin production without impacting thrombin time[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This finding indicates that alterations in TEG are not aligned with changes in conventional coagulation markers in clinical risk women for pre-eclampsia. Additionally, multivariate analysis revealed that APTT was linked to pre-eclampsia development, with each 1-second prolongation of APTT increasing the risk of pre-eclampsia by 1.160-fold. Xu C et al. [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]also observed in their study that patients with pre-eclampsia exhibited prolonged APTT, consistent with the findings of our study. This may be related to the progressive consumption of blood clotting factors during the course of pre-eclampsia, which may contribute to hypocoagulability.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study confirms that low-dose aspirin (50-100mg/day) initiated at 16\u0026ndash;28 weeks' gestation significantly prevents pre-eclampsia in high-risk women without increasing obstetric or neonatal risks. Importantly, TEG emerges as a clinically valuable tool for monitoring aspirin's anticoagulant effects, objectively guiding treatment by assessing hypercoagulability correction. These findings support TEG's potential role in optimizing aspirin prophylaxis for individualized pre-eclampsia prevention.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study had three important potential limitations. Firstly, the selection of clinical risk factors for pre-eclampsia recommended by ISSHP was adhered to, which may differ from those recommended by other guidelines. It is not feasible to include all potential risk factors in the study. For instance, multiple pregnancy was examined as one of the intermediate risk factors, whereas ACOG guidelines classify it as an independent risk factor. In this study, assisted reproduction and BMI\u0026thinsp;\u0026gt;\u0026thinsp;30 are considered independent high-risk factors, whereas ACOG and NICE guidelines classify them as moderate-risk factors. Furthermore, regarding age, this study and ACOG classify age\u0026thinsp;\u0026gt;\u0026thinsp;40 as an moderate-risk factors, while NICE considers age\u0026thinsp;\u0026gt;\u0026thinsp;35 as an moderate-risk factors. Additionally, family history of pre-eclampsia was not included as a risk factor in the study, in contrast to ACOG and NICE guidelines. Secondly, in view of the retrospective design, TEG data were collected from 26 weeks of pregnancy until delivery. The extensive time span and variations in blood coagulation status across pregnancies, coupled with the small sample size, may introduce bias to the TEG data. Thirdly, considering postpartum hemorrhage as a potential complication of aspirin therapy, our study would benefit from a more comprehensive assessment. While we evaluated only postpartum blood loss, parameters such as postpartum hemoglobin levels, blood transfusion requirements, and 24-hour postpartum blood loss were not included, indicating a need for more thorough investigation in future studies.\u003c/p\u003e\u003cp\u003eDespite these limitations, our study retrospectively provided valuable real-world data on the prophylactic use of aspirin in pregnant women with clinical risk factors for pre-eclampsia. Additionally, it further confirmed the efficacy and safety of aspirin in this population and offered guidance for interpreting TEG findings to assess aspirin's effect on coagulation function. However, further research is needed to validate these findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and was approved by the \u0026nbsp;Medical Ethics Committee of Shenzhen People\u0026apos;s Hospital, Retrospective study exempt informed consent.（Ethical approval abtained：LL-KY-2023166-01）\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors consent to publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by grants from the Shenzhen Science and Technology Program (Grant NOs\u003c/p\u003e\n\u003cp\u003eJCYJ20220530152216036), the Shenzhen Key Medical Discipline Construction Fund (Grant No. SZXK059) and Shenzhen Key Laboratory of Prevention and Treatment of Severe Infections (ZDSYS20200811142804014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXue-hong ZHANG collected,analyzed the data, and drafted the manuscrept. Qiu-ling CHEN revised \u0026nbsp;the manuscrept. Kuan LI designed the study, interpreted the data, and revised the manuscript. Huanzhe Zhao, Jin-li Liu , Yong Liu participated in data collation. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to all the teachers who provided assistance with this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e[Diagnosis and treatment of hypertension. pre-eclampsia in pregnancy: a clinical practice guideline in China(2020)]. Zhonghua fu chan ke za zhi. 2020;55(4):227\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe International Federation of Gynecology. and Obstetrics (FIGO) initiative on pre-eclampsia: A pragmatic guide for first‐trimester screening and prevention. Int J Gynecol Obstet. 2019;145.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYuping W, Yang G, Yanping Z, David FL. Evidence of endothelial dysfunction in preeclampsia: decreased endothelial nitric oxide synthase expression is associated with increased cell permeability in endothelial cells from preeclampsia. Am J Obstet Gynecol. 2004;190(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAnouk B, Mirjam vW, Ben Willem M, Christianne JM, dG. Preeclampsia; short and long-term consequences for mother and neonate. Early Hum Dev. 2016;102(0).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePhipps E, Prasanna D, Brima W, Jim B. mini-review preeclampsia: updates in pathogenesis, definitions, and guidelines. 2018.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGoodlin R, Haesslein H, Fleming J. Aspirin for the treatment of recurrent toxaemia. Lancet (London England). 1978;2(8079):51.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChappell L, Cluver C, Kingdom J, Tong S. Pre-eclampsia. Lancet (London England). 2021;398(10297):341\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEvdokia D, Daniel LR, Wei Z, Guadalupe E-G, Kaori K, Rossana PVF et al. Pre-eclampsia. Nat Rev Dis Primers. 2023;9(1).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHofmeyr G, Lawrie T, Atallah \u0026Aacute;, Torloni M. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database Syst Rev. 2018;10(10):CD001059.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRodger M, Gris J, de Vries J, Martinelli I, Rey \u0026Eacute;, Schleussner E, et al. Low-molecular-weight heparin and recurrent placenta-mediated pregnancy complications: a meta-analysis of individual patient data from randomised controlled trials. Lancet (London England). 2016;388(10060):2629\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBrownfoot F, Hastie R, Hannan N, Cannon P, Tuohey L, Parry L, et al. Metformin as a prevention and treatment for preeclampsia: effects on soluble fms-like tyrosine kinase 1 and soluble endoglin secretion and endothelial dysfunction. Am J Obstet Gynecol. 2016;214(3):356. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e.e1-.e15\u003c/span\u003e\u003cspan address=\"http://.e1-.e15\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLoussert L, Vidal F, Parant O, Hamdi SM, Vayssiere C, Guerby P. Aspirin for prevention of preeclampsia and fetal growth restriction. Prenat Diagn. 2020;40.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRoberge S, Nicolaides K, Demers S, Hyett J, Chaillet N, Bujold E. The role of aspirin dose on the prevention of preeclampsia and fetal growth restriction: systematic review and meta-analysis. Am J Obstet Gynecol. 2017;216(2):110\u0026ndash;. \u0026ndash;\u0026thinsp;20.e6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNaimi A, Perkins N, Sjaarda L, Mumford S, Platt R, Silver R, et al. The Effect of Preconception-Initiated Low-Dose Aspirin on Human Chorionic Gonadotropin-Detected Pregnancy, Pregnancy Loss, and Live Birth: Per Protocol Analysis of a Randomized Trial. Ann Intern Med. 2021;174(5):595\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDuley L, Meher S, Hunter K, Seidler A, Askie L. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2019;2019(10).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO recommendations on. antiplatelet agents for the prevention of pre-eclampsia. 2021 2021.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGestational Hypertension and Preeclampsia. ACOG Practice Bulletin Summary, Number 222. Obstet Gynecol. 2020;135(6):1492\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMagee LA, Brown MA, Hall DR, Gupte S, Hennessy A, Karumanchi SA, et al. The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis \u0026amp; management recommendations for international practice. Pregnancy Hypertens. 2022;27:148\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStefanovic V. International Academy of Perinatal Medicine (IAPM) guidelines for screening, prediction, prevention and management of pre-eclampsia to reduce maternal mortality in developing countries. J Perinat Med. 2023;51(2):164\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMendoza M, Bonacina E, Garcia-Manau P, L\u0026oacute;pez M, Caami\u0026ntilde;a S, Vives \u0026Agrave;, et al. Aspirin Discontinuation at 24 to 28 Weeks' Gestation in Pregnancies at High Risk of Preterm Preeclampsia: A Randomized Clinical Trial. JAMA. 2023;329(7):542\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e!!! INVALID CITATION !!! [20\u0026ndash;27].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGuan J, Cong Y, Ren J, Zhu Y, Li L, Deng X, et al. Comparison between a new platelet count drop method PL-11, light transmission aggregometry, VerifyNow aspirin system and thromboelastography for monitoring short-term aspirin effects in healthy individuals. Platelets. 2015;26(1):25\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShao T, Cheng Y, Jin J, Huang L, Yang D, Luo C, et al. A comparison of three platelet function tests in ischemic stroke patients with antiplatelet therapy. J Clin neuroscience: official J Neurosurgical Soc Australasia. 2020;78:91\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMan W, Zheng H, Qun XC, Jun X, Chao L. The ability of thromboelastography parameters to predict severe pre-eclampsia when measured during early pregnancy. Int J Gynaecol Obstet. 2019;145(2).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCurry N, Davenport R, Pavord S, Mallett S, Kitchen D, Klein A, et al. The use of viscoelastic haemostatic assays in the management of major bleeding: A British Society for Haematology Guideline. Br J Haematol. 2018;182(6):789\u0026ndash;806.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKarlsson O, Sporrong T, Hillarp A, Jeppsson A, Hellgren M. Prospective longitudinal study of thromboelastography and standard hemostatic laboratory tests in healthy women during normal pregnancy. Anesth Analg. 2012;115(4):890\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShreeve N, Barry J, Deutsch L, Gomez K, Kadir R. Changes in thromboelastography parameters in pregnancy, labor, and the immediate postpartum period. Int J Gynaecol Obstet. 2016;134(3):290\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAskie L, Duley L, Henderson-Smart D, Stewart L. Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet (London England). 2007;369(9575):1791\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRolnik D, Wright D, Poon L, O'Gorman N, Syngelaki A, de Paco Matallana C, et al. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017;377(7):613\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLiu F, Zhao M, Wang M, Yang H, Li L. Effect of regular oral intake of aspirin during pregnancy on pregnancy outcome of high-risk pregnancy-induced hypertension syndrome patients. Eur Rev Med Pharmacol Sci. 2016;20(23):5013\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin L, Huai J, Li B, Zhu Y, Juan J, Zhang M, et al. A randomized controlled trial of low-dose aspirin for the prevention of preeclampsia in women at high risk in China. Am J Obstet Gynecol. 2022;226(2):251. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e.e1-.e12\u003c/span\u003e\u003cspan address=\"http://.e1-.e12\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGan J, He H, Qi H. Preventing preeclampsia and its fetal complications with low-dose aspirin in East Asians and non-East Asians:A systematic review and meta-analysis. Hypertens Pregnancy. 2016;35(3):426\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHenderson J, Vesco K, Senger C, Thomas R, Redmond N. Aspirin Use to Prevent Preeclampsia and Related Morbidity and Mortality: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2021;326(12):1192\u0026ndash;206.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu T, Zhou F, Deng C, Huang G, Li J, Wang X. Low-Dose Aspirin for Preventing Preeclampsia and Its Complications: A Meta-Analysis. J Clin Hypertens (Greenwich Conn). 2015;17(7):567\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHoffman MK, Goudar SS, Kodkany BS, Metgud M, Wallace D. Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): a randomised, double-blind, placebo-controlled trial. Lancet. 2020;395(10220):285\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSouter V, Painter I, Sitcov K, Khalil A. Propensity score analysis of low-dose aspirin and bleeding complications in pregnancy. Ultrasound Obstet gynecology: official J Int Soc Ultrasound Obstet Gynecol. 2024;63(1):81\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLidan H, Jianbo W, Liqin G, Jifen H, Lin L, Xiuyan W. The Diagnostic Efficacy of Thrombelastography (TEG) in Patients with Preeclampsia and its Association with Blood Coagulation. Open life Sci. 2019;14:335\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKasitanon N, Hamijoyo L, Li M, Oku K, Navarra S, Tanaka Y, et al. Management of non-renal manifestations of systemic lupus erythematosus: A systematic literature review for the APLAR consensus statements. Int J Rheum Dis. 2022;25(11):1220\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSzczeklik A, Krzanowski M, G\u0026oacute;ra P, Radwan J. Antiplatelet drugs and generation of thrombin in clotting blood. Blood. 1992;80(8):2006\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eXu C, Li Y, Zhang W, Wang Q. Analysis of perinatal coagulation function in preeclampsia. Medicine. 2021;100(26):e26482.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShaheen G, Sajid S, Jahan S. Evaluation of coagulation factors and serum ferritin in preeclamptic Pakistani women. JPMA J Pakistan Med Association. 2020;70(11):2048\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"thromboelastography, pre-eclampsia, aspirin, coagulation indicators, platelet","lastPublishedDoi":"10.21203/rs.3.rs-6929594/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6929594/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackgroud \u003c/strong\u003ePre-eclampsia (PE), a hypertensive disorder uniquely associated with human pregnancy, poses a significant risk to both maternal and fetal health. The prophylactic administration of aspirin has been widely acknowledged as a strategy to mitigate the incidence of pre-eclampsia. However, despite its global recognition, a consensus on the optimal methodology for evaluating the efficacy of aspirin in preventing pre-eclampsia remains elusive.This study investigate the Utility of Thromboelastography (TEG) in Assessing the Efficacy and Safety of Aspirin for Preventing PE by Analyzing TEG Parameters.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003eMaternal cases from a tertiary hospital in Shenzhen between January 1, 2019, and March 31, 2023, were selected for TEG assessment after 26 weeks of pregnancy. Outpatient and inpatient medical records, along with data from the Shenzhen Maternal and Child Health Care Management Information System, were retrospectively reviewed. Pregnant women were categorized into control (62 cases), risk (62 cases), and aspirin (50 cases) groups based on the presence of pre-eclampsia (PE) risk factors, aspirin prophylaxis, and discharge criteria. TEG parameters, platelet counts, and coagulation indexes were compared among the groups, and differences in each parameter were analyzed. Maternal and neonatal outcomes were also compared, assessing the efficacy and safety of aspirin. Factors influencing the occurrence of pre-eclampsia were determined using binary logistic regression analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eSignificant differences were observed in the incidence of pre-eclampsia (8.06%, 30.65%, 10.00%, P=0.001), cesarean section (58.06%, 79.03%, 76.00%, P=0.023), and preterm delivery (16.13%, 40.32%, 26.00%, P=0.010) among the three groups. TEG parameters, including R value (X\u003csup\u003e2\u003c/sup\u003e=12.977, P=0.011) and CI (X\u003csup\u003e2\u003c/sup\u003e=12.357, P=0.015), exhibited significant differences across the groups. Coagulation index TT values also significantly differed among the three groups (H=13.567, P=0.001). Multivariate analysis identified prophylactic aspirin use as a protective factor against pre-eclampsia development (OR 0.357, 95%CI 0.120-1.066).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eThis study demonstrates that low-dose aspirin effectively prevents pre-eclampsia in high-risk pregnancies without additional risks, while TEG proves valuable for monitoring aspirin's anticoagulant effects and guiding individualized treatment.\u003c/p\u003e","manuscriptTitle":"Utilizing Thromboelastography to Assess the Efficacy and Safety of Aspirin in Preventing Pre-eclampsia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-27 11:03:26","doi":"10.21203/rs.3.rs-6929594/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b4b47863-1ba6-4bc9-8658-8a6613cd3a8f","owner":[],"postedDate":"July 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-18T09:54:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-27 11:03:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6929594","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6929594","identity":"rs-6929594","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}