Successful Intra-Arterial Thrombolysis for Acute Ischemic Stroke in the Immediate Postpartum Period: Case Report

Méndez, José; Masjuán, Jaime; Garcia, Nelda; Leciñana, M. de

doi:10.1007/s00270-006-0033-8

Cited by 23 publications

(15 citation statements)

References 14 publications

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“…One was a case report of intra-arterial alteplase (20 mg) 6 days postpartum, 152 and the other was a case report of intra-arterial urokinase (110 000 U) 15 hours after cesarean section. 153 Neither was complicated by sICH or vaginal bleeding. …”

Section: Strokementioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

532

220

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Purpose-To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 24, 2015, and the American Heart Association Executive Committee on October 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The online-only Data Supplement, which contains literature search strategies and Figures A, B, and C, is available with this article at http://circ. ahajournals.org/lookup/suppl/doi:10.1161/STR.0000000000000086/-/DC1.The American Heart Association requests that this document be cited as follows: Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rational...

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Section: Strokementioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

532

220

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“…20 Successful use of IA thrombolysis has been described after cardiac catheterization, immediately postpartum, postcesarian section, and in the early perioperative period including after cardiac surgery. [21][22][23][24][25] In a series of 13 cardiac surgery patients treated with IA tissue plasminogen activator (tPA), 38% of treated patients had neurologic improvement although 2 patients required transfusion (1 with hemothorax and 1 with a small ICH). 25 The largest series described 36 patients from a mixed postoperative population who had ischemic stroke were treated with IA thrombolysis.…”

mentioning

confidence: 99%

In-Hospital Ischemic Stroke

Cumbler

2015

The Neurohospitalist

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Between 2.2% and 17% of all strokes have symptom onset during hospitalization in a patient originally admitted for another diagnosis or procedure. These in-hospital strokes represent a unique population with different risk factors, more mimics, and substantially worsened outcomes compared to community-onset strokes. The fact that these strokes manifest during the acute care hospitalization, in patients with higher rates of thrombolytic contraindications, creates distinct challenges for treatment. However, the best evidence suggests benefit to treating appropriately selected in-hospital ischemic strokes with thrombolysis. Evidence points toward a ''quality gap'' for in-hospital stroke with longer in-hospital delays to evaluation and treatment, lower rates of evaluation for etiology, and decreased adherence to consensus quality process measures of care. This quality gap for in-hospital stroke represents a focused opportunity for quality improvement.

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“…There is no direct evidence for the safety of thrombolytic therapy in pregnancy, because pregnant women were excluded from randomized therapeutic trials. Recently, several case reports of tPA use during pregnancy in patients with stroke, pulmonary embolism and renal artery thrombosis were published [91,[158][159][160][161][162][163][164][165]. Even though in many patients it was safe with no complications, one review study of 172 pregnant patients reported maternal hemorrhages in as high as 8% [166].…”

Section: Thrombolytic Therapymentioning

confidence: 97%

“…Intuitively, the effectiveness of tPA should not be affected by pregnancy. Several case reports showed successful use of intravenous and intra-arterial tPA in stroke with complete resolution of symptoms or major improvement of neurological function [165,168].…”

Section: Thrombolytic Therapymentioning

confidence: 99%

Stroke in pregnant and postpartum women

Sidorov

Feng

Caplan

2011

Expert Review of Cardiovascular Therapy

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Ischemic infarcts and hemorrhages are uncommon but dangerous complications of pregnancy. Their etiology is related to physiological changes during pregnancy. The majority of strokes are seen in the third trimester and postpartum and are etiologically related to three conditions: reversible cerebral vasoconstriction syndrome, preeclampsia/eclampsia and cerebral venous thrombosis. The first two conditions are etiologically connected and can lead to ischemic and hemorrhagic events, whereas cerebral sinus thrombosis is mainly related to hypercoagulation and causes venous infarcts and brain hemorrhages. MRI and CT scans are safe to use for diagnosis of stroke in pregnancy, although use of iodine-based contrast may affect thyroid function of the neonate. Management of stroke in pregnancy is specific to cause and depends on management of blood pressure and delivery in preeclampsia/eclampsia, expected management or calcium channel blockers in reversible cerebral vasoconstriction syndrome, and anticoagulation for cerebral sinus thrombosis.

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Successful Intra-Arterial Thrombolysis for Acute Ischemic Stroke in the Immediate Postpartum Period: Case Report

Cited by 23 publications

References 14 publications

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

In-Hospital Ischemic Stroke

Stroke in pregnant and postpartum women

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