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

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.

Germline BAP1 mutation in a family with high incidence of multiple primary cancers and a potential gene-environment interaction.

We report a high-risk cancer family with multiple mesotheliomas, cutaneous melanomas, basal cell carcinomas, and meningiomas segregating with a germline nonsense mutation in BAP1 (c.1938T>A; p.Y646X). Notably, most (four of five) mesotheliomas were peritoneal rather than the usually more common pleural form of the disease, and all five mesothelioma patients also developed second or third primary cancers, including two with meningiomas. Another family member developed both cutaneous melanoma and breast cancer. Two family members had basal cell carcinomas, and six others had melanocytic tumors, including four cutaneous melanomas, one uveal melanoma, and one benign melanocytic tumor. The family resides in a subtropical area, and several members had suspected exposure to asbestos either occupationally or in the home. We hypothesize that the concurrence of a genetic predisposing factor and environmental exposure to asbestos and UV irradiation contributed to the high incidence of multiple cancers seen in this family, specifically mesothelioma and various uveal/skin tumors, respectively.