Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124, Bari, Italy.
Division of Cardiology, "A. Manzoni" Hospital, Lecco, Italy.
J Thromb Thrombolysis. 2020 Jan;49(1):145-148. doi: 10.1007/s11239-019-01939-1.
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.
妊娠相关性急性心肌梗死是一种罕见的疾病，通常发生在妊娠的第三个 trimester，与同年龄非孕妇相比，死亡率高出三到四倍。与非孕妇相同，在 ST 段抬高型心肌梗死的情况下，最有效的治疗方法是经皮冠状动脉介入治疗和支架植入。不幸的是，这些患者的治疗可能具有挑战性，因为人们对最佳的医学策略知之甚少；第三代噻吩吡啶的潜在致畸作用也尚未完全确定。事实上，目前的指南并没有提供足够的建议，根据孕妇的缺血情况调整双联抗血小板治疗的处方。此外，现行的共识文件没有说明剖宫产/子宫切除术的出血风险分类。我们报告了第二例妊娠相关性急性心肌梗死病例，该病例在左冠状动脉经皮冠状动脉介入治疗和药物洗脱支架植入术前后成功使用替格瑞洛治疗，但也是首例因剖宫产而暂时停用替格瑞洛时使用替罗非班桥接抗血小板治疗的报告。
