Key result
An urgent Caesarean section was successfully performed without excessive bleeding in a 32-year-old woman on uninterrupted ticagrelor <24 hours after primary PCI.
Why the study?
Caesarean section is a challenging intervention in patients treated with dual antiplatelet therapy.
Can an urgent Caesarean section be safely performed without discontinuing ticagrelor in a pregnant woman on dual antiplatelet therapy shortly after primary PCI?
Case Report (n=1)
Can an urgent Caesarean section be safely performed without discontinuing ticagrelor in a pregnant woman on dual antiplatelet therapy shortly after primary PCI?
This case report provides the first evidence that urgent Caesarean section may be successfully performed without excessive bleeding in a patient on uninterrupted ticagrelor and aspirin shortly after primary PCI, when local hemostatic measures are applied.
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.
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Antonijević et al. (2023) conducted a case report in Acute myocardial infarction complicated by cardiogenic shock in pregnancy (n=1). Caesarean section without discontinuation of ticagrelor was evaluated on Excessive bleeding and fetal outcome. An urgent Caesarean section was successfully performed without excessive bleeding in a 32-year-old woman on uninterrupted ticagrelor <24 hours after primary PCI.
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