Aspirin Continuation Until Delivery in Pregnant Patients with Coronary Heart Disease
For pregnant patients with coronary heart vessel disease taking aspirin, continue the medication daily until delivery—do not stop at a predetermined gestational age. 1, 2, 3, 4
Primary Recommendation Based on Current Guidelines
The American College of Obstetricians and Gynecologists explicitly recommends continuing low-dose aspirin daily until delivery in pregnant women taking it for cardiovascular indications. 1, 2, 3, 4 This applies directly to your patient with coronary heart vessel disease, as the cardiovascular protection is needed throughout pregnancy and into the early postpartum period when thrombotic risk remains elevated. 1
Key Supporting Evidence
Multiple international guidelines from the USA, Canada, Ireland, New Zealand, and the UK specify continuation until delivery rather than stopping at any predetermined gestational age (such as 36 weeks). 1
The rationale is that thrombotic and ischemic risk persists throughout pregnancy and even into the early postpartum period—stopping aspirin prematurely removes critical cardiovascular protection during a high-risk time. 1, 2
Low-dose aspirin (75-81 mg daily) does not increase risks of placental abruption, postpartum hemorrhage, fetal intracranial bleeding, or perinatal mortality when continued until delivery. 1, 2, 3, 4
Critical Distinction: Low-Dose vs. High-Dose Aspirin
It is essential to understand that the FDA warning about aspirin in the third trimester refers to high-dose aspirin (>100 mg), not the low prophylactic doses (75-81 mg) used for cardiovascular protection. 1, 5 The FDA label states concerns about "the last 3 months of pregnancy" but this applies to analgesic/anti-inflammatory doses, not cardioprotective doses. 5
Common Pitfalls to Avoid
Do not stop aspirin at 36 weeks "just to be safe"—this is not evidence-based and removes protection during a critical high-risk period for cardiovascular events. 1, 2
Do not confuse cardiovascular indications with preeclampsia prophylaxis—while some recent research suggests aspirin for preeclampsia prevention may be safely stopped at 24-28 weeks in selected low-risk patients with normal biomarkers 6, this does NOT apply to patients with underlying coronary heart disease who require aspirin for secondary cardiovascular prevention. 1, 2
Do not stop aspirin 1-2 days before planned cesarean delivery—the American College of Obstetricians and Gynecologists advises against this practice as it may adversely affect blood pressure control and cardiovascular stability, particularly in high-risk women. 2
Special Considerations for Coronary Heart Disease
For patients with established coronary heart vessel disease:
The indication for aspirin is secondary prevention of cardiovascular events, not preeclampsia prophylaxis—this is a fundamentally different risk-benefit calculation. 7, 8
Cardiovascular risk remains elevated throughout pregnancy and the postpartum period due to increased cardiac output, hypercoagulability, and hemodynamic stress. 1
One case report describes successful continuation of dual antiplatelet therapy (aspirin plus clopidogrel) until one week before delivery in a pregnant woman with coronary artery disease, resulting in successful delivery at 36 weeks without complications. 7
Practical Management Algorithm
Continue aspirin 75-81 mg daily throughout pregnancy until delivery 1, 2, 3, 4
Do not stop for planned cesarean delivery—maintain cardiovascular protection and blood pressure control 2
If cesarean delivery is required, ensure blood pressure is controlled with antihypertensive medications as needed to keep BP <160/110 mmHg using first-line agents (IV labetalol, oral nifedipine, or IV hydralazine) 2
Only consider stopping aspirin if there are specific bleeding complications (e.g., placental abruption, active hemorrhage)—but this would be a case-by-case clinical decision, not routine practice 2