International Journal of Infertility & Fetal Medicine

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VOLUME 14 , ISSUE 3 ( September-December, 2023 ) > List of Articles


An Adverse Obstetric Event Following Conversion of DAPT to a Single Antiplatelet Agent in a Pregnant Woman with Coronary Artery Disease Treated by Angioplasty: A Case Report

Vignesh Durai, Poojitha K Kanikaram, Papa Dasari

Keywords : Acute coronary syndrome, Case report, Coronary artery disease, Intrauterine fetal death, Myocardial infarction, Postprimary percutaneous transluminal angioplasty, Primary infertility

Citation Information : Durai V, Kanikaram PK, Dasari P. An Adverse Obstetric Event Following Conversion of DAPT to a Single Antiplatelet Agent in a Pregnant Woman with Coronary Artery Disease Treated by Angioplasty: A Case Report. Int J Infertil Fetal Med 2023; 14 (3):143-147.

DOI: 10.5005/jp-journals-10016-1321

License: CC BY-NC 4.0

Published Online: 28-11-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: To describe the adverse fetal outcome at term due to discontinuation of clopidogrel before delivery in woman with coronary artery disease who was on dual antiplatelet therapy (DAPT) for 5 years. Background: Acute myocardial infarction (MI) during pregnancy is reported more often than pregnancy outcomes in woman with coronary artery disease (CAD). The recommendation regarding the mode of delivery in women with preexisting CAD is not uniform, and the role of continuing DAPT before delivery is a matter of debate in the literature. Case description: A 38-year-old primigravida with a history of CAD for 5 years was hospitalized at 37 weeks for safe confinement. She was a tailor by occupation and was diagnosed with CAD 5 years ago, for which she underwent primary percutaneous transluminal angioplasty with an everolimus-eluting stent of the left anterior descending (LAD) artery. She has been taking tablet (Tab) aspirin, Tab clopidogrel, β-blockers, and statins since then. She was married for 20 years and was investigated for primary infertility. Her cycles were irregular, and she was diagnosed with polycystic ovary syndrome (PCOS), treated with oral ovulogens without success, and stopped further fertility treatment when diagnosed with CAD. She recognized herself as pregnant only at 32 weeks. She was scheduled to be delivered by elective cesarean section (CS) at 38 weeks. The cardiologist and the anesthesiologist advised her to stop clopidogrel 1 week before CS. She suffered from sudden intrauterine fetal demise (IUFD) the day before the scheduled CS and went into labor. She was delivered by emergency cesarean, and the stillborn baby weighed 3.4 kg. Conclusion: Discontinuing DAPT in pregnant women with CAD may lead to IUFD. Clinical significance: Continuing DAPT from pregnancy till delivery or substituting with heparin to prevent thrombosis is essential, possibly preventing sudden intrauterine death. The benefits should be weighed against the risk of bleeding when such therapy is stopped.

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