Key result
Urgent Caesarean section was successfully performed without excessive bleeding in a 32-year-old woman on uninterrupted ticagrelor and aspirin less than 24 hours after primary PCI for acute MI.
Why the study?
Cesarean section presents a clinical challenge in patients treated with dual antiplatelet therapy.
Case Report (n=1)
This case report suggests that urgent Caesarean section may be performed without excessive bleeding in a patient on uninterrupted ticagrelor and aspirin following recent primary PCI, when guided by platelet aggregometry and using local hemostatic measures.
May support urgent cesarean on uninterrupted ticagrelor-aspirin shortly after PCI; hypothesis-generating and should not yet change practice.
Cesarean section is a challenge intervention in patients treated with dual antiplatelet therapy. We present case of 32 years old pregnant woman experiencing large acute myocardial infarction (MI) of anterolateral wall complicated by cardiogenic shock in the 38th week of pregnancy treated with drug-eluting stent implantation and dual antiplatelet therapy (DAPT) consisting of aspirin and ticagrelor. Less than 24 hours after MI delivery started, 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, 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 and aspirin was evaluated on Bleeding and maternal/fetal outcome. Urgent Caesarean section was successfully performed without excessive bleeding in a 32-year-old woman on uninterrupted ticagrelor and aspirin less than 24 hours after primary PCI for acute MI.
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