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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.

Introduction: The current number of women in the reproductive phase (from 15 to 45 years) in Europe is estimated at about 105 million, with about 5 million children annually born in average. About 1% of pregnancies among women in Europe are complicated by heart disease, the risk of cardiovascular disease in pregnant women being further increased by the fact that ever older women are giving birth. Methods: Preparing this paper is based on a systematic PubMed search of existing professional databases and accessible medical journals and textbooks dealing with this subject matter. Topic: Being certainly drugs with the best anticoagulant effect in situations of high risk for thrombosis, especially in patients with mechanical prosthetic heart valves during pregnancy, vitamin K antagonists (VKA) on the other hand also entail a well-known dose-related risk of embryo toxicity, genotoxicity, and hemorrhage in the fetus and in the mother. The choice of appropriate anticoagulant depends on the stage of pregnancy. In accordance with the North-American guidelines (American College of Chest Physicians - ACCP) for women already on oral vitamin K antagonists actively trying to conceive frequent pregnancy tests, and substitution of VKA with heparin drugs when pregnant are recommended rather than VKA replacement with low molecular weight heparin (Low Molecular Weight Heparin - LMWH) when planning a pregnancy. Heparin derivatives have no embryo toxic and fetotoxic characteristic effects of VKA but they are less effective at preventing valve thrombosis, due to which they have recently been superseded by improved techniques for monitoring effects of heparin, with a mentioned made that low molecular weight heparin used in high therapeutic doses requires obligatory (on a weekly basis) monitoring of anti-factor Xa coagulation activities. Conclusion: Adequate anticoagulant therapy during pregnancy requires an analysis of risk factors for thrombosis, hemorrhage risk, consideration of comorbidities in pregnant women, especially renal function, especially taking into account the gestational age. Though it must be admitted that there is no absolutely safe anticoagulant therapy during pregnancy, a choice of the safest option regarding the stated risks for the mother and the child is of paramount importance.

Background/Aim. Data about bleeding complicating primary percutaneous coronary intervention (PCI) are more frequently obtained from randomized clinical trials on patients with acute coronary syndromes (ACS), but less frequently from surveys or registries on patients with STelevation myocardial infarction (STEMI). The aim of this study was to investigate the incidence, predictors and prognostic impact of in-hospital major bleeding in the population of unselected real-world patients with acute STEMI undergoing primary PCI. Methods. All consecutive patients presenting with STEMI who underwent primary PCI at a single large tertiary healthcare center between January 2005 and July 2009, were studied. Major bleeding was defined according to the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) study criteria. We examined the association between in-hospital major bleeding and death or major adverse cardiac events (MACE) in patients treated with PCI. The primary outcomes were in-hospital and 6-month mortality and MACE. Results. Of the 770 STEMI patients treated with primary PCI, in-hospital major bleeding occurred in 32 (4.2%) patients. Independent predictors of major bleeding were advanced age (≥ 65 years), female gender, baseline anemia and elevated white blood cell (WBC) count and signs of congestive heart failure at admission (Killip class II-IV). In-hospital and 6-month mortality and MACE rates were more than 2.5-fold-higher in patients who developed major bleeding compared with those who did not. Major bleeding was a predictor of 6- month MACE, independent of a few risk factors (previous MI, previous PCI, diabetes mellitus and hypertension); (OR = 3.02; 95% CI for OR 1.20-7.61; p = 0.019), but was not a true independent predictor of MACE and mortality in the fully adjusted models. Conclusion: Patients of advanced age, female gender, with baseline anemia and elevated WBC count and those with Killip class II-IV at presentation are at particularly high risk of bleeding after primary PCI. Bleeding is associated with adverse outcome and may be an important marker of patient frailty, but it is not a true independent predictor of mortality/MACE.