(736) The Impact of Implementation of a Universal Low-Dose Aspirin Protocol

Objective:
Low dose aspirin (LDA) is recommended for preeclampsia prophylaxis in high-risk women, but uptake based on this risk-based approach is poor nationally, despite attempted quality improvement (QI) and educational tools. We sought to improve LDA use through implementation of universal LDA.

Study Design:
We performed a QI project transitioning from risk-based LDA to universal LDA (LDA for all pregnant patients) receiving prenatal care from 4/2024-6/2025. Baseline data were collected from 4-6/2024 with transition to universal LDA on 7/1/2024. Starting at baseline, all patients were asked at each visit about LDA use, number of missed doses, and if LDA was recommended by their provider; all responses were documented in the electronic medical record (EMR). Providers were notified of these EMR changes and the transition to universal LDA; staff education was provided quarterly along with performance reports. The primary outcome was overall LDA use depicted by a monthly run chart. Secondary analysis was limited to those satisfying risk-based LDA criteria. Quarterly outcomes in this group were compared using P-values for trend.

Results:
Between 4/2024-6/2025,13,756 individuals met inclusion. At baseline, 27.0% of patients reported LDA use despite 66.3% meeting risk-based criteria; by the end of the QI study period, 64.9% reported LDA use with 57.1% meeting risk-based criteria (p< 0.001) (Figure 1). Amongst those that met risk-based criteria, LDA use increased (baseline 32.5% to Q4 62.3%, p< 0.001); both in those meeting criteria by high-risk factors and moderate-risk factors alone (p< 0.001)(Figure 2). In addition, there was an increase in LDA compliance (those reporting “zero” when asked how many doses were missed in the last 14 days, baseline 58.9% to Q4 66.2%, p< 0.001) and patient recall of provider recommendation if they were not taking LDA (baseline 4.3% to Q4 22.5%, p< 0.001).

Conclusion:
A universal recommendation for LDA increased LDA use and compliance in our total population and in those meeting risk-based criteria. Given the improved uptake of LDA, improvement in clinical outcomes should be evaluated.