Key result
Bridging clopidogrel with eptifibatide and using thromboelastography to guide neuraxial analgesia allowed for a successful operative vaginal delivery and uncomplicated recovery.
Case Report (n=1)
Bridging clopidogrel with eptifibatide and using thromboelastography to assess hemostatic function allowed for safe neuraxial analgesia and delivery in a pregnant patient with a recent bare metal stent.
May support individualized bridging in pregnant patients with recent stents; leaves open need for prospective safety data.
A 31-year-old woman at 32 weeks' gestation presented with an ST segment elevation myocardial infarction with subsequent bare metal stent placement. A multidisciplinary team coordinated the delivery plan, including anticoagulation and delivery mode. Because the patient was at high risk for stent thrombosis, clopidogrel was discontinued after 4 weeks and bridged with eptifibatide for 7 days. Eptifibatide was stopped for induction of labor. Twelve hours after eptifibatide was discontinued, hemostatic function was assessed with thromboelastography before initiating neuraxial analgesia. A successful operative vaginal delivery was performed, followed by an uncomplicated recovery. Clopidogrel was resumed 24 hours postpartum.
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Bauer et al. (2012) conducted a case report in ST segment elevation myocardial infarction in pregnancy (n=1). Peripartum management including clopidogrel bridging with eptifibatide and thromboelastography-guided neuraxial analgesia was evaluated on Successful delivery and recovery. Bridging clopidogrel with eptifibatide and using thromboelastography to guide neuraxial analgesia allowed for a successful operative vaginal delivery and uncomplicated recovery.
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