Antiplatelet therapy in pregnant women – benefit and risk Review article
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Published:
Sep 30, 2015
Keywords:
pregnancy, acetylsalicylic acid, antiplatelet therapy, anti-infammatory therapy
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Abstract
In the era of increasing number of pregnant women receiving antiplatelet or antitrombotic therapy, it seems necessary to more accurately understand the mechanism of interaction of these drugs, both in the mother and foetus tissues. The drug therapy in these patients should be very carefully considered because of its potential toxicity and teratogenicity on the foetus. Acetylsalicylic acid (ASA), whose effect is the main subject of this study, is a drug used more and more often in obstetric failures and conditions requiring antiplatelet therapy. Treatment with low-dose ASA during pregnancy is relatively safe; however, it involves a risk of foetal gastroschisis.
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Jagodzińska , A., Pietrzak , B., Cudnoch-Jędrzejewska , A., & Mamcarz , A. (2015). Antiplatelet therapy in pregnant women – benefit and risk. Cardiology in Practice, 9(3), 3-11. Retrieved from https://journalsmededu.pl/index.php/kwp/article/view/1332
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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References
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28. Kaandorp S.P., Goddijn M., van der Post J.A. et al.: Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. N. Eng. J. Med. 2010; 362(17): 1586-1596.
29. Visser J., Ulander V., Bloemenkamp K. et al.: A randomised controlled multicenter study: the effect of enoxaparin and/or aspirin on prevention of recurrent miscarriage in women with or without thrombophilia, HABENOX-study. Int. J. Gynecol. Obst. 2009.
30. Giancotti A., Torre R.L., Spagnuolo A. et al.: Efficacy of three different antithrombotic regimens on pregnancy outcome in pregnant women affected by recurrent pregnancy loss. J. Matern. Fetal. Neonatal. Med. 2012; 25(7): 1191-1194.
31. Sebastian C., Scherlag M., Kugelmass A. et al.: Primary stent implantation for acute myocardial infarction during pregnancy: use of abciximab, ticlopidine, and aspirin. Cathet. Cardiovasc. Diagn. 1998; 45(3): 275-279.
32. Kozer E., Nikfar S., Costei A. et al.: Aspirin consumption during the first trimester of pregnancy and congenital anomalies: a meta-analysis. Am. J. Obstet. Gynecol. 2002; 187(6): 1623-1630.
33. Werler M.M., Sheehan J.E., Mitchell A.A.: Maternal medication use and risks of gastroschisis and small intestinal atresia. Am. J. Epidemiol. 2002; 155(1): 26-31.
34. Robson S., Owen P., Martin W. et al.: The Investigation and Management of the Small-for-Gestational-Age Fetus. Green-top Guideline No. 31, February 2013.
2. Bręborowicz G.: Położnictwo i ginekologia, tom 1, PZWL, Warszawa 2010.
3. Fayomi O., Nazar R.: Acute myocardial infarction in pregnancy: a case report and subject review. Emerg. Med. J. 2007; 24(11): 800-801.
4. Askie L.M., Duley L., Henderson-Smart D.J. et al.: Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data. Lancet 2007; 369(9575): 1791-1798.
5. Bańkowski E.: Biochemia. Podręcznik dla studentów uczelni medycznych. Elsevier, Wrocław 2009: 448-449.
6. Rang H.P., Dale M.M.: Farmakologia, wydanie 2, Elsevier, Wrocław 2014.
7. Regan L., Backos M., Rai R. et al: Royal College of Obstetricians and Gynaecologists. The Investigation and Treatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage. Green-top guideline 2011; 17: 1-18.
8. Empson M., Lassere M., Craig J. et al.: Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant. Cochrane Database Syst. Rev. 2005; 2 (CD002859).
9. Duley L., Henderson-Smart D.J., Meher S. et al.: Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst. Rev. 2007; (2): CD004659.
10. Schramm A.M., Clowse M.E.: Aspirin for prevention of pre-eclampsia in lupus pregnancy. Autoimmune Dis 2014; 2014: 920467.
11. Szczeklik A., Gajewski P.: Interna Szczeklika. Podręcznik chorób wewnętrznych 2013, Medycyna Praktyczna, Warszawa 2013.
12. Bramham K., Hunt B.J., Germain S. et al.: Pregnancy outcome in different clinical phenotypes of antiphospholipid syndrome. Lupus 2010; 19(1): 58-64.
13. Regan L., Backos M., Rai R. et al.: Royal College of Obstetricians and Gynaecologists. The Investigation and Treatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage. Green-top guideline 2011; 17: 1-18.
14. Galli M.: Treatment of the antiphospholipid syndrome. Auto. Immun. Highlights. 2013; 5(1): 1-7.
15. Lopez-Pedrera C., Aguirre M.A., Ruiz-Limon P. et al.: Immunotherapy in antiphospholipid syndrome. Int. Immunopharmacol. 2015; 27(2): 200-208.
16. Brunton L.L., Lazo J.S.: Farmakologia Goodmana i Gilmana, tom 1, wydanie 1, Czelej, Lublin 2007.
17. Hohlfeld T., Schrör K.: Anti-inflammatory effects of aspirin in ACS: relevant to its cardio coronary actions? Thromb. Haemost. 2015; 114(3): 469-477.
18. National Institute for Health and Care Excellence, Hypertension in Pregnancy: The management of hypertensive disorders during pregnancy 2010.
19. Lausman A., McCarthy F.P., Walker M, et al.: SOGC Clinical Practice Guideline, Intrauterine Growth Restriction: Screening, Diagnosis, and Management. J. Obstet. Gynaecol. Can. 2012; 34(1): 17-28.
20. Poon L.C., Nicolaides K.H.: First-trimester maternal factors and biomarker screening for pre-eclampsia. Prenat. Diagn. 2014; 34(7): 618-627.
21. Duley L., Henderson-Smart D.J., Meher S. et al.: Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst. Rev. 2007; 2: CD004659.
22. Trivedi N.A.: A meta-analysis of low-dose aspirin for prevention of pre-eclampsia. J. Postgrad. Med. 2011; 57(2): 91-95.
23. Bartsch E., Park A.L., Kingdom J.C. et al.: Risk threshold for starting low dose aspirin in pregnancy to prevent pre-eclampsia: an opportunity at a low cost. PLoS. One. 2015; 10(3): e0116296.
24. Giuliano N., Annunziata M.L., Tagliaferri S.: IUGR management: new perspectives. J. Pregnancy 2014: 620976.
25. Bujold E., Roberge S., Lacasse Y.: Prevention of pre-eclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a metaanalysis. Obstet. Gynecol. 2010.
26. Roberge S., Nicolaides K.H., Demers S. et al.: Prevention of perinatal death and adverse perinatal outcome using low-dose aspirin: a meta-analysis. Ultrasound Obstet. Gynecol. 2013; 41(5): 491-499.
27. Jeve Y.B., Davies W.: Evidence-based management of recurrent miscarriages. J. Hum. Reprod. Sci. 2014; 7(3): 159-169.
28. Kaandorp S.P., Goddijn M., van der Post J.A. et al.: Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. N. Eng. J. Med. 2010; 362(17): 1586-1596.
29. Visser J., Ulander V., Bloemenkamp K. et al.: A randomised controlled multicenter study: the effect of enoxaparin and/or aspirin on prevention of recurrent miscarriage in women with or without thrombophilia, HABENOX-study. Int. J. Gynecol. Obst. 2009.
30. Giancotti A., Torre R.L., Spagnuolo A. et al.: Efficacy of three different antithrombotic regimens on pregnancy outcome in pregnant women affected by recurrent pregnancy loss. J. Matern. Fetal. Neonatal. Med. 2012; 25(7): 1191-1194.
31. Sebastian C., Scherlag M., Kugelmass A. et al.: Primary stent implantation for acute myocardial infarction during pregnancy: use of abciximab, ticlopidine, and aspirin. Cathet. Cardiovasc. Diagn. 1998; 45(3): 275-279.
32. Kozer E., Nikfar S., Costei A. et al.: Aspirin consumption during the first trimester of pregnancy and congenital anomalies: a meta-analysis. Am. J. Obstet. Gynecol. 2002; 187(6): 1623-1630.
33. Werler M.M., Sheehan J.E., Mitchell A.A.: Maternal medication use and risks of gastroschisis and small intestinal atresia. Am. J. Epidemiol. 2002; 155(1): 26-31.
34. Robson S., Owen P., Martin W. et al.: The Investigation and Management of the Small-for-Gestational-Age Fetus. Green-top Guideline No. 31, February 2013.