Ivie Odiase, MD, on universal aspirin implementation for reducing preeclampsia risk

While conducting clinical rotations at St. Barnabas Hospital in the Bronx, Ivie Odiase, MD, now an obstetrics and gynecology resident at Mount Sinai West, identified a significant gap in the use of aspirin for preeclampsia prevention. “I started this project to see in our population, how many people [who] met criteria for aspirin prophylaxis by ACOG were actually receiving it,” said Odiase. A retrospective analysis revealed that only 30% of eligible patients were prescribed aspirin.

The findings from this quality improvement project were presented at the 2025 ACOG Annual Clinical and Scientific Meeting.

A shift to universal prescribing

Citing ACOG guidance that allows for universal aspirin in high-risk or underserved populations, the team at St. Barnabas shifted to a universal aspirin prescribing protocol. Odiase explained that the decision was influenced by systemic barriers: “The reason why many providers were not providing aspirin was not because they were missing key steps, [but] because of the time constraints that appointment has, and also the high risk natures of patients.”

Following the presentation of these findings at Grand Rounds, St. Barnabas implemented universal aspirin prescribing. Educational initiatives included clinician training, office posters, and patient-facing flyers. As a result, the aspirin prescribing rate rose from 30% to 99% among eligible patients. “I think universal aspirin eliminated the bias or the things that could go wrong with the provider… and increased the amount of patients who actually needed it,” said Odiase.

Evaluating the risk-benefit balance

Odiase emphasized the clinical value of aspirin in reducing preeclampsia risk: “There’s not a zero risk, but a small risk of bleeding. But… when you do a risk-benefit analysis… the benefit that it can potentially have… outweighs the risk.” She underscored the severity of preeclampsia and the challenge it presents for clinicians making early delivery decisions. “The only real treatment is delivery… clinicians have to make a tough choice of delivering a patient at 28, 30, 32 weeks… but the mothers have preeclampsia, and they worry about the patient having a stroke, going into seizure, having liver, kidney failure.”

Overcoming implementation challenges

Initial reactions from providers highlighted both surprise and skepticism, particularly at the low baseline prescribing rate. Educational outreach, including Grand Rounds presentations and department meetings, played a key role in changing provider behavior. Patient communication posed another challenge. “Patients had a ton of questions that could not be answered in their 10 or 15-minute visit,” said Odiase. Flyers and posters—available in English and Spanish—were created to help educate patients about the new universal aspirin approach.

Next steps: Measuring impact on preeclampsia rates

The team is now in the second phase of the project, continuing education and planning additional interventions. “Our next step now is to add a smart phrase or a checkpoint in Epic so now providers don’t miss it,” said Odiase. Chart reviews are underway to evaluate whether the universal aspirin initiative has reduced preeclampsia rates since its implementation began in February 2024. “We’re hopeful that it will… but again, that’s something that we’re just continuing—universal implementation—so we can have a larger population to study.”

Disclosure:

No relevant disclosures

Reference:

Grimaldi MY, Boucaud DE, Odiase I, Argeros O. Increasing the Use of Low-Dose Aspirin for Preeclampsia Prevention Through Universal Implementation [ID 1336]. Obstetrics & Gynecology 145(6S):p 8S, June 2025. doi:10.1097/AOG.0000000000005916.026