MANAGEMENT OF ANTIPLATELET THERAPY DURING ACUTE CORONARY SYNDROME (ACS) IN PREGNANT WOMEN: CASE REPORT AND LITERATURE REVIEW

Introduction: The occurrence of ACS during pregnancy is a serious event but remains rare with a trend towards increase. Its incidence is 3-4 times more common in pregnant women/non-pregnant women of childbearing age. Spontaneous coronary dissection and atherosclerosis represent the most common causes of ACS in pregnant women.

Observation: We report the clinical case of a young parturient, who presented at 31weeks of amenorrheaan ACS without ST segment elevation (NSTEMI) on tight and layered lesions of the anterior interventricular artery (IVA). She underwent active stent angioplasty with dual antiplatelet therapy. Delivery in our patient was plannedat 38 weeks after assessment of fetal and maternal well-being. However, the patient underwent emergency surgery at 37 weeks+2 days (obstetrical emergency) with favorable maternal and fetal outcomes.

Discussion and Conclusion: The management of ACS in pregnant women is difficult it relies on collaboration between anesthesiologists, cardiologists and obstetricians in specialized health centers. Discontinuation of P2Y12 inhibitors around childbirth exposes the parturient to a very significant risk of stent thrombosis. The data concerning the relay by the Glycoprotein IIa/IIIb inhibitors are poor. The aim of our study is to take stock of the management strategy of antiplatelet therapy during the peripartum as well as the antagonization strategy to consider in the event of emergency delivery in a patient on dual antiplatelet therapy.