Anesthesia & Analgesia · 2012 · 14 citations · 17 references
MedicinePerioperative MedicineSurgeryInterventional CardiologyObstetric AnesthesiaPerioperative PharmacologyAnticoagulant ManagementAntiplatelet TherapyAntithrombotic TherapyThrombosisThrombosis ManagementThrombosis PreventionAntithrombotic Therapy After Stent ImplantationIn-stent ThrombosisMode Of Delivery PlanningMultidisciplinary Team ManagementPeriprocedural Antiplatelet TherapyPharmacologic Labor AnalgesiaPostpartum Neuraxial AnalgesiaPregnancy-related Anticoagulation
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.
17