Complexities of oral antiplatelet drugs use in pregnancy

Abstract

Introduction: Given the increasing occurrence of pregnancy at a relatively older age in the current clinical practice, many therapeutic approaches characteristically used in the elderly population are becoming an important consideration point for the clinicians. Antiplatelet drugs: The safety of antiplatelet drug administration in pregnancy should be brought into a sharper focus regarding both mother and child. It is a complex clinical task since the pregnancy is followed by many changes potentially affecting the drug choice-increased blood coagulability, changes in platelet aggregation, and pharmacokinetic alternations of the drug itself. Acetylsalicylic acid, as the most commonly used antiplatelet drug, appears to be mostly safe and effective for mother and fetus in many conditions occurring during pregnancy when used in low doses. However, although considered generally safe, its use requires careful approach due to many drug and pregnancy specificities. On the other hand, evidence showing adequate clinical use of P2Y12 receptor antagonists (clopidogrel, ticagrelor, prasugrel, and ticlopidine) are scarce. Cases showing their use in clinical practice are emerging and the future practice and treatment approach might be changed with the new cases becoming available. Conclusion: Regardless of the drug, pregnancy itself and any indication for the treatment used in this patient population are typically complex and require well-coordinated management by the interdisciplinary clinical team.

Antiplatelet Drugs Use in Pregnancy—Review of the Current Practice and Future Implications

“…Based on the available safety and efficacy data, the European Society of Cardiology (ESC) Scientific Document Group developed clinical guidelines regarding the use of aspirin in pregnancy and accepted the use of low dose aspirin when indicated in pregnant women. The use of aspirin in pregnancy is presented in Table 1 (adopted from the 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy) [ 1 , 16 ].…”

“…Besides previously mentioned European guidelines, the American College of Chest Physicians (ACCP) also provides a set of recommendations for the use of aspirin during pregnancy which can be seen in Table 2 [ 16 , 17 ].…”

“…Level of evidence: A—Data derived from multiple randomized clinical trials or meta-analyses. This table is re-used from authors’ previous work [ 16 ].…”

“…Level of evidence: Grade B—moderate; Grade C—low. This table is re-used from authors’ previous work [ 16 ].…”