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PreeclampsiaEarly Phase 1NCT05709483

Predictors of Aspirin Failure in Preeclampsia Prevention

A Early Phase 1 study testing Aspirin in people with Preeclampsia, run by Rockefeller University at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

Hypertensive disorders of pregnancy (including preeclampsia) are among the leading causes of pregnancy complications and maternal deaths worldwide. They also increase the risks to the babies. Numerous interventions have been suggested in order to reduce the rate of preeclampsia. Read more about this study

Who is it for?
Ages 18 to 45 years, women onlyHealthy volunteers can take part
Conditions the study is for
Preeclampsia
What is being tested?
Aspirin
Could I receive a placebo?
No, everyone receives an active treatment
How many people
130 participants
Where
1 siteUnited States
Study dates
13 Apr 2023to 1 Nov 2026
Phase
Early Phase 1
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 45 years
  • Women only
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • Women aged 18-45 years with prior history of preeclampsia who received low dose aspirin in their subsequent gestation and either did or did not have a recurrence of preeclampsia.
  • Aspirin was given in their subsequent pregnancy in a 81 mg dose prior to 16 weeks of gestation, and was taken with a self-reported compliance rate of at least 80%
  • Subsequent pregnancy lasted beyond 20 weeks of gestation
  • Willingness to abstain from non-prescription non-steroidal anti-inflammatory drugs (NSAIDs), which are known to interfere with platelet function assays, for one week prior to platelet function analyses.
  • Healthy controls recruited for SNP assay optimization:
  • Women aged 18 years or older, with no other specific inclusion criteria that need to be met in order to be enrolled for the study.

Who cannot join

  • Age <18 years or >45 years
  • Any clinically significant adverse reaction to aspirin on prior exposure
  • Known bleeding disorder based on personal or family history
  • History of kidney or liver impairment
  • Current pregnancy
  • Current use of antithrombotic agents (e.g., aspirin, clopidogrel, warfarin, direct acting oral anticoagulants).
Show all 14Show fewer
  • Chronic hypertension (systolic blood pressure >140 mmHG or diastolic pressure >90 mmHG, or use of antihypertensive drugs or diagnosis made by clinician)
  • Diabetes mellitus
  • Current known malignancy
  • History of hemorrhagic stroke
  • Participants may be excluded at the discretion of the investigator for medical, psychological or other reasons
  • Rockefeller students, and Rockefeller employees in the Coller lab, are excluded from participation.
  • Healthy controls:
  • <18 years of age. B. Participants may be excluded at the discretion of the investigator for medical, psychological or other reasons C. Rockefeller students, and Rockefeller employees in the Coller lab, are excluded from participation.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Recruitment Office contact

1-800-782-2737

RUcares@Rockefeller.edu

Amihai Rottenstreich, MD contact

+1-2123277245

arottenstr@rockefeller.edu

United States1 site, 1 recruiting
  • Rockefeller University

    New York, New York, 10065

    Amihai Rottenstreich, MD, 212-327-7245, arottenstr@rockefeller.edu

    Recruiting

Other trials in United States

About this study

Official title: Genetic, Laboratory and Clinical Factors Associated With Low-dose Aspirin Failure in the Prevention of Preeclampsia- An Exploratory Protocol

Hypertensive disorders of pregnancy (including preeclampsia) are among the leading causes of pregnancy complications and maternal deaths worldwide. They also increase the risks to the babies. Numerous interventions have been suggested in order to reduce the rate of preeclampsia. Low-dose aspirin is the most beneficial prophylactic approach in this regard. Nevertheless, aspirin failure is not uncommon. The genetic, laboratory, and clinical factors associated with low-dose aspirin failure in the prevention of preeclampsia are largely unknown. The presence of a genetic variant in PAR4 receptor expressed on platelets, is associated with increased platelet function and possibly with aspirin failure.

Read the detailed description

Preeclampsia is among the leading causes of maternal morbidity and mortality worldwide. The pathophysiology underling the occurrence of preeclampsia is multifactorial with many suggested theories. Among the latter, enhanced platelet activation coupled with an imbalance in prostanoid levels have been postulated as being responsible for the pathophysiologic changes in preeclampsia.

Numerous prophylactic interventions have been investigated in order to reduce the rate of gestational hypertensive disorders. It is currently well-established that administration of low-dose aspirin is the most beneficial prophylactic approach.

The major effect of aspirin is to inhibit cyclooxygenase-1 (COX-1), which reduces thromboxane A2 production in platelets and the abnormally increased thromboxane A2/prostaglandin I2 imbalance.

This improves placental function by favoring systemic vasodilatation and inhibiting platelet aggregation. Despite its well-established clinical role in the prevention of preeclampsia, aspirin failure is not uncommon. Nevertheless, the ancestry/genetic, laboratory, and clinical factors associated with low-dose aspirin failure in the prevention of preeclampsia are largely unknown.

Higher rates of aspirin failure have been reported in Black women, possibly due to genetic variants. Studies among non-pregnant patients, have identified that racial differences in PAR4 (protease- activated receptor 4) expressed on platelets, are associated with increased platelet function in Blacks compared to whites. A single-nucleotide variant (rs773902) in PAR4 gene (F2RL3), which results in alanine/threonine polymorphism, was shown to largely account for the racial difference in platelet activation by PAR4. The frequency of the variant differs widely between self-declared Black individuals and non-Black individuals, with values of ~65% versus~20%. Thus, it is possible that the variant may contribute to the higher rate of failure of low dose aspirin in the Black population.

The study aim is to evaluate these issues.

Conditions
Preeclampsia
Being tested
Aspirin
Medical subject headings
Pre-Eclampsia

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • AspirinDrug

    Platelet assays including VerifyNow Aspirin assay, VerifyNow Base assay, platelet aggregometry, Thromboxana A2 levels- will be measured at baseline and 1 hour after administration of single-dose enteric-coated 81 mg aspirin

Study groups in NCT05709483
Study groupRoleWhat they receive
Women with prior history of preeclampsia who received aspirin in subsequent gestationExperimentalSingle-dose of enteric-coated 81 mg aspirin
Receives: Drug: Aspirin
Healthy volunteersNo interventionIn this group, no aspirin will be given, as blood draw will not be performed at all among the healthy volunteers. The group of healthy volunteers will serve only for the SNP assay development.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Allelic frequency of the PAR4 variant (rs773902) in relation to aspirin success in preeclampsia prevention

    We will compare the the allelic frequency of the PAR4 variant (rs773902) between aspirin-responders (no recurrence of preeclampsia) and aspirin non responders (recurrence of preeclampsia despite aspirin)

    Measured: At study enrollment

Secondary outcomes (4)
  1. Platelet response to aspirin as assessed by VerifyNow Aspirin Assay in relation to aspirin success in preeclampsia prevention-measured as VerifyNow Reaction Units

    In the VerifyNow aspirin assay- arachidonic acid is used as the activator to measure the response of the platelet to aspirin. Aspirin irreversibly inhibits COX-1, the enzyme that catalyzes the first reaction leading to the conversion of arachidonic acid to thromboxane A2, which in turn, activates the GPIIb/IIIa receptor to bind fibrinogen, which leads to platelet aggregation. In the presence of aspirin the aggregation does not occur. This assay will demonstrate whether those who developed preeclampsia despite aspirin administration, have increased platelet aggregation at baseline, at 1 hour following aspirin administration, or both.

    Measured: 0 and 1 hours post single dose 81 mg enteric-coated aspirin

  2. Platelet response to aspirin as assessed by VerifyNow Base Assay in relation to aspirin success in preeclampsia prevention-measured as VerifyNow Reaction Units

    In the VerifyNow Base assay, platelet activation is produced by PAR1 thrombin receptor activating peptide + a PAR4 agonist peptide. Thus, this assay will be used to assess whether there is an enhanced response of the PAR4 peptide in those with the PAR4 variant, or perhaps even in those who did not have a good response to aspirin even if they do not have the variant.

    Measured: 0 and 1 hours post single dose 81 mg enteric-coated aspirin

  3. Platelet response to aspirin as assessed by aggregometry in relation to aspirin success in preeclampsia prevention-measured as VerifyNow Reaction Units

    As in the VerifyNow Base assay, the Base channel includes both PAR1 and PAR4 agonists, we will also perform platelet aggregometry with just the PAR4 agonist peptide, to avoid any confounding effect of the PAR1 peptide. This will be measured at baseline and at 1 hour after aspirin administration. Results will be compared between those who developed preeclampsia depicted aspirin and those who did not experience preeclampsia under aspirin prophylaxis.

    Measured: 0 and 1 hours post single dose 81 mg enteric-coated aspirin

  4. Thromboxane A2 levels in relation to aspirin success in preeclampsia prevention-measured in ng/mL

    Aspirin inhibits the enzyme COX-1 which converts arachidonic acid to thromboxane A2. Therefore, evaluating the end product directly-thromboxane A2 levels-may potentially detect differences between the groups (aspirin responders vs. aspirin non-responders).

    Measured: 0 and 1 hours post single dose 81 mg enteric-coated aspirin

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Feb 2023
  2. Study start13 Apr 2023
  3. Primary completion1 Nov 2026 (estimated)
  4. Study completion1 Nov 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Early Phase 1
Primary purpose
Basic science
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
130 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05709483
Sponsor's protocol ID
ARO-1039
Status last verified
Oct 2025
First submitted
11 Jan 2023
Last updated
30 Oct 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No

Publications

  • Bokslag A, van Weissenbruch M, Mol BW, de Groot CJ. Preeclampsia; short and long-term consequences for mother and neonate. Early Hum Dev. 2016 Nov;102:47-50. doi: 10.1016/j.earlhumdev.2016.09.007. Epub 2016 Sep 20.

    PubMed 27659865
  • Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet. 2005 Feb 26-Mar 4;365(9461):785-99. doi: 10.1016/S0140-6736(05)17987-2.

    PubMed 15733721
  • Duley L, Henderson-Smart DJ, Meher S, King JF. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004659. doi: 10.1002/14651858.CD004659.pub2.

    PubMed 17443552
  • Redman CW, Bonnar J, Beilin L. Early platelet consumption in pre-eclampsia. Br Med J. 1978 Feb 25;1(6111):467-9. doi: 10.1136/bmj.1.6111.467.

    PubMed 626836
  • Roberts MS, Joyce RM, McLeod LJ, Vial JH, Seville PR. Slow-release aspirin and prostaglandin inhibition. Lancet. 1986 May 17;1(8490):1153-4. doi: 10.1016/s0140-6736(86)91865-9. No abstract available.

    PubMed 2871403
  • Rolnik DL, Wright D, Poon LC, O'Gorman N, Syngelaki A, de Paco Matallana C, Akolekar R, Cicero S, Janga D, Singh M, Molina FS, Persico N, Jani JC, Plasencia W, Papaioannou G, Tenenbaum-Gavish K, Meiri H, Gizurarson S, Maclagan K, Nicolaides KH. Aspirin versus Placebo in Pregnancies at High Risk for Preterm Preeclampsia. N Engl J Med. 2017 Aug 17;377(7):613-622. doi: 10.1056/NEJMoa1704559. Epub 2017 Jun 28.

    PubMed 28657417
  • Tolcher MC, Sangi-Haghpeykar H, Mendez-Figueroa H, Aagaard KM. Low-dose aspirin for preeclampsia prevention: efficacy by ethnicity and race. Am J Obstet Gynecol MFM. 2020 Nov;2(4):100184. doi: 10.1016/j.ajogmf.2020.100184. Epub 2020 Jul 21.

    PubMed 33345910
  • Johnson JD, Louis JM. Does race or ethnicity play a role in the origin, pathophysiology, and outcomes of preeclampsia? An expert review of the literature. Am J Obstet Gynecol. 2022 Feb;226(2S):S876-S885. doi: 10.1016/j.ajog.2020.07.038. Epub 2020 Jul 24.

    PubMed 32717255
  • Edelstein LC, Simon LM, Lindsay CR, Kong X, Teruel-Montoya R, Tourdot BE, Chen ES, Ma L, Coughlin S, Nieman M, Holinstat M, Shaw CA, Bray PF. Common variants in the human platelet PAR4 thrombin receptor alter platelet function and differ by race. Blood. 2014 Nov 27;124(23):3450-8. doi: 10.1182/blood-2014-04-572479. Epub 2014 Oct 7.

    PubMed 25293779
  • Edelstein LC, Simon LM, Montoya RT, Holinstat M, Chen ES, Bergeron A, Kong X, Nagalla S, Mohandas N, Cohen DE, Dong JF, Shaw C, Bray PF. Racial differences in human platelet PAR4 reactivity reflect expression of PCTP and miR-376c. Nat Med. 2013 Dec;19(12):1609-16. doi: 10.1038/nm.3385. Epub 2013 Nov 10.

    PubMed 24216752

Questions about this trial

What is this clinical trial studying?

A Early Phase 1 study testing Aspirin in people with Preeclampsia, run by Rockefeller University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 14 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 30 Oct 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Early Phase 1 (sometimes called Phase 0) studies give a very small amount of a treatment to a few people, mainly to see how the body handles it.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Recruitment Office (1-800-782-2737, RUcares@Rockefeller.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Allelic frequency of the PAR4 variant (rs773902) in relation to aspirin success in preeclampsia prevention (time frame: At study enrollment). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05709483, which also lists 10 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 30 Oct 2025.

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