Ticagrelor and tirofiban in pregnancy and delivery: beyond labels.
Donatella ArgentieroStefano SavonittoPaola D'AndreaFortunato IacovelliPublished in: Journal of thrombosis and thrombolysis (2020)
Pregnancy-associated acute myocardial infarction is a rare condition usually occurring during the third trimester of pregnancy, and associated with three-to-four-fold higher mortality compared with rates among non-pregnant women of the same age. As in non-pregnant women, in cases of ST elevation myocardial infarction, the most effective treatment is primary percutaneous coronary intervention with stent implantation. Unfortunately, management of these patients could be challenging because little is known about the optimal medical strategy; the potential teratogenic effects of the third generation thienopyridines are not fully established too. In fact current guidelines do not provide enough recommendations about tailoring dual antiplatelet therapy prescription according to ischemic profile of the pregnant patients. Moreover, the bleeding risk class of cesarean delivery/hysterectomy is not stated in current consensus documents. We report the second pregnancy-associated acute myocardial infarction case successfully treated with ticagrelor before and after primary percutaneous coronary intervention with drug eluting stent implantation on left coronary artery, but also the first report on use of bridging antiplatelet therapy with tirofiban during temporary withdrawal of ticagrelor because of a C-section.
Keyphrases
- percutaneous coronary intervention
- antiplatelet therapy
- acute myocardial infarction
- st elevation myocardial infarction
- acute coronary syndrome
- st segment elevation myocardial infarction
- pregnant women
- coronary artery disease
- coronary artery bypass grafting
- pregnancy outcomes
- end stage renal disease
- atrial fibrillation
- coronary artery
- preterm birth
- chronic kidney disease
- ejection fraction
- coronary artery bypass
- newly diagnosed
- prognostic factors
- healthcare
- peritoneal dialysis
- type diabetes
- ischemia reperfusion injury
- pulmonary hypertension
- clinical practice
- cardiovascular events
- left ventricular
- cardiovascular disease
- pulmonary arterial hypertension
- smoking cessation
- brain injury
- climate change