Clopidogrel and pregnancy: a situation pregnant with danger?

Excerpt

The risk of central neuraxial blockade and perioperative bleeding in patients with coronary artery disease (CAD) and coronary artery stents in situ treated with newer antiplatelet drugs (e.g., clopidogrel) usually in combination with aspirin is unclear [1‐3]. Clopidogrel (Plavix, Bristol-Myers Squibb Co., New York, NY, USA) demonstrates both time- and dose-dependent effects; steady state for clopidogrel is achieved within 7 days [1, 3]. Labeling recommends, “if a patient is to undergo elective surgery, and an antiplatelet effect is not desired, clopidogrel should be discontinued 7 days prior to surgery.” I herein report a case of a parturient with CAD, status post-recent coronary artery stenting (on clopidogrel and aspirin) awaiting planned induction of labor who developed severe bleeding following minor nonobstetric surgery a day prior to her scheduled delivery. Despite adhering to standard guidelines concerning administration of aspirin peripartum (perioperatively) and stopping the clopidogrel more than 7 days before the planned induction of labor and anesthetic, the patient developed bleeding after otherwise minor cosmetic surgery. In fear of an epidural-spinal hematoma no neuraxial blockade was performed for delivery [4]. …