Successful gestation and delivery using clopidogrel for secondary stroke prophylaxis: a case report and literature review

Abstract

Literature is scarce regarding the use of clopidogrel during pregnancy and the potential hazard to maternal and fetal health. We report a 33-year-old female, who presented to our clinic at 40 weeks gestation with a history of multiple prior ischemic strokes and transient ischemic attacks. The patient was placed on clopidogrel for secondary stroke prophylaxis prior to conception and maintained therapy throughout pregnancy without interruption or complication. Clopidogrel was discontinued 7 days prior to induction of labor, and a healthy baby was vaginally delivered without bleeding complications or congenital anomalies. Clopidogrel was restarted 12 hours postpartum without an incident. To our knowledge, this is the first report of clopidogrel use in pregnancy for secondary stroke prophylaxis. We also provide a current review of the literature of the use of clopidogrel in pregnancy. Based on the limited data available, clopidogrel use in pregnancy has not demonstrated significant toxicity to either the mother or the newborn. However, additional studies are needed to further assess the efficacy and safety of this medication in this patient population.

Pregnancy, Hormonal Treatments for Infertility, Contraception, and Menopause in Women After Ischemic Stroke

“…However, Clopidogrel has been reported to be successfully resumed after delivery. 20 Furthermore, prasugrel has been maintained for 15 months after delivery without complications, 23 while…”

“…Only one case report has been published on a successful gestation and delivery during clopidogrel use for secondary stroke prevention. 20 Regarding dipiridamole, the use of dipyridamole together with low doses of aspirin during pregnancies at high risk for preeclampsia has been reported to lower the incidence of preeclampsia, fetal loss, and fetal growth retardation, while abnormal bleeding was not reported for mothers and neonates. 21 Only single case reports on women with previous MI using prasugrel or ticagrelor during pregnancy without negative results have been recently published 22,23 .…”

Use of ticagrelor in human pregnancy, the first experience

“…Potential complications in pregnancy could include: antenatal vaginal bleeding, placental abruption, postpartum haemorrhage, placental transmission resulting in fetal/neonatal bleeding and eventual problems due to haemorrhage during neuraxial anaesthesia. Clopidogrel is the most widely used P2Y12R antagonist 2. Several recently reviewed reports on the use of clopidogrel in pregnancy have been published.…”

Heart disease in pregnancy

“…Limited data from case reports show that clopidogrel, a second-generation thienopyridine, is not associated with significant foetal risk [23]. If dual antiplatelet is required after coronary artery stenting, then clopidogrel with aspirin should be used for the shortest duration possible, and then aspirin should be continued alone.…”