Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Women & Infants Hospital of Rhode Island, Providence, Rhode Island.
Obstet Gynecol. 2019 Apr;133(4):725-728. doi: 10.1097/AOG.0000000000003167.
The July 2018 American College of Obstetricians and Gynecologists' guidelines for aspirin prophylaxis for preeclampsia prevention represent a departure from prior, more stringent guidelines and extend eligibility for aspirin prophylaxis to a large proportion of pregnant women in the United States. However, these latest guidelines are predicated on a complex, risk-factor-based screening algorithm and ignore the reality that, outside of the setting of clinical research, effective implementation of risk-factor-based approaches consistently falls short. Herein we argue for transitioning to universal aspirin prophylaxis for preeclampsia prevention using the concept of libertarian paternalism, knowing that altering the choice architecture from an "opt-in" to an "opt-out" system will greatly increase the number of patients who receive the advantage of this inexpensive, safe, and beneficial preventative intervention.
2018 年 7 月，美国妇产科医师学会（American College of Obstetricians and Gynecologists）发布了预防子痫前期的阿司匹林预防指南，这与之前更严格的指南有所不同，并将阿司匹林预防的适用范围扩大到了美国很大一部分孕妇。然而，这些最新的指南是基于一个复杂的、基于风险因素的筛查算法，并且忽略了一个事实，即在临床研究之外，基于风险因素的方法的有效实施始终存在差距。在这里，我们主张通过自由意志主义家长主义的概念，将子痫前期的预防从普遍的阿司匹林预防转变为普遍的阿司匹林预防，我们知道，将选择结构从“选择加入”改为“选择退出”系统，将大大增加接受这种廉价、安全和有益的预防干预的患者数量。
