title: Peripartum management of dual antiplatelet therapy and neuraxial labor analgesia after bare metal stent insertion for acute myocardial infarction.
abstract: 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.
authors.affiliation: Department of Anesthesiology, Division of Obstetric Anesthesiology, University of Michigan Health System, Ann Arbor, MI 48109-5278, USA. mbalun@med.umich.edu
authors.forename: Melissa E B
authors.initials: ME
authors.lastname: Bauer
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Bauer
authors.forename: Amir B
authors.initials: AB
authors.lastname: Rabbani
authors.forename: Jill M
authors.initials: JM
authors.lastname: Mhyre
mesh_terms: D000328:Adult; D016362:Analgesia, Obstetrical; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000008:administration & dosage; D000077144:Clopidogrel; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D008670:Metals; D009203:Myocardial Infarction / Q000628:therapy*; D009407:Nerve Block; D010455:Peptides / Q000008:administration & dosage; D058725:Peripartum Period; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000628:therapy*; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D008670:Metals; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D000077542:Eptifibatide; D013988:Ticlopidine; D001241:Aspirin