Successful Caesarean Section on Ticagrelor Treatment One Day after Primary Percutaneous Coronary Intervention.
Nebojsa AntonijevicPredrag MitrovicNikola GosnjicDejan OrlicSasa KadijaTanja Ilic MosticNebojsa SavicLjubica BirovljevZaklina LekovicDragan M MaticPublished in: Journal of personalized medicine (2023)
Caesarean section is a challenging intervention in patients treated with dual antiplatelet therapy. We present a case of a 32-year-old pregnant woman experiencing large acute myocardial infarction (MI) of the anterolateral wall, complicated by cardiogenic shock in the 38th week of pregnancy, and treated with drug-eluting stent implantation and dual antiplatelet therapy (DAPT) consisting of aspirin and ticagrelor. Less than 24 h after the MI delivery started, an urgent Caesarean section was indicated. As multiplate aggregometry testing showed a relatively insufficient level of ticagrelor platelet inhibition and a moderate level of aspirin platelet inhibition, a Caesarean section was performed without discontinuation of ticagrelor, which was decided due to the need for emergency surgery. Local hemostatic measures including administration of tranexamic acid were applied. The patient did not experience excessive bleeding. A healthy male baby was born. To the best of our knowledge, this is the first reported case of surgery in pregnant women treated with DAPT without ticagrelor discontinuation.
Keyphrases
- antiplatelet therapy
- percutaneous coronary intervention
- coronary artery bypass
- acute myocardial infarction
- acute coronary syndrome
- st segment elevation myocardial infarction
- st elevation myocardial infarction
- pregnant women
- coronary artery disease
- coronary artery bypass grafting
- minimally invasive
- atrial fibrillation
- healthcare
- randomized controlled trial
- case report
- emergency department
- public health
- clinical trial
- newly diagnosed
- pregnancy outcomes
- body mass index
- low dose
- heart failure
- physical activity
- surgical site infection
- gestational age