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Ticagrelor and tirofiban in pregnancy and delivery: beyond labels

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Abstract

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.

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Acknowledgements

We would like to thank Dr. Vitantonio Russo and Dr. Francesca Pierri, from the Division of Cardiology of the “SS. Annunziata” Hospital of Taranto (Italy), for such off-label effective antiplatelet management of the patient during the admission for ST elevation myocardial infarction and at the time of delivery.

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Correspondence to Fortunato Iacovelli.

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Argentiero, D., Savonitto, S., D’Andrea, P. et al. Ticagrelor and tirofiban in pregnancy and delivery: beyond labels. J Thromb Thrombolysis 49, 145–148 (2020). https://doi.org/10.1007/s11239-019-01939-1

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Keywords

  • Pregnancy
  • Cesarean section
  • Acute myocardial infarction
  • Percutaneous coronary intervention
  • Ticagrelor
  • Tirofiban