Systemic thrombolysis for stroke in pregnancy

Tassi, Rossana; Acampa, Maurizio; Marotta, Giovanna; Cioni, Samuele; Guideri, Francesca; Rossi, Simone; Cerase, Alfonso; Martini, Giuseppe

doi:10.1016/j.ajem.2012.05.040

Cited by 45 publications

(29 citation statements)

References 5 publications

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“…Our knowledge about its use in this condition is based on case reports or case series. 3 Data from case studies has shown that thrombolysis is effective in ischemic strokes with a relative low risk to mother and foetus. 3 Thrombolysis for ischaemic strokes should be considered after discussion with the obstetric team and the patient.…”

Section: Medical Problems In Pregnancymentioning

confidence: 99%

“…3 Data from case studies has shown that thrombolysis is effective in ischemic strokes with a relative low risk to mother and foetus. 3 Thrombolysis for ischaemic strokes should be considered after discussion with the obstetric team and the patient. The risks and benefits should be explained to the patient before administrating systemic thrombolysis.…”

Section: Medical Problems In Pregnancymentioning

confidence: 99%

“…Thrombolytic therapy complications include pre-term labour, placental abruption, foetal death, post-partum haemorrhage and possible teratogenicity. 3 Acute stroke treatment decision-making is a complex process that must be performed quickly. 4 With obstetric back-up, intravenous rt-PA should be administered followed by 'rescue' mechanical thrombectomy in situations where no clinical improvement is seen.…”

Section: Medical Problems In Pregnancymentioning

confidence: 99%

“…3 Topiramate and valproate are both licensed for migraine treatment but should not be offered to pregnant patient as they are teratogenic.…”

Section: Medical Problems In Pregnancymentioning

confidence: 99%

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Medical problems in pregnancy

Sah

Kausar

2017

Clinical Medicine

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Section: Medical Problems In Pregnancymentioning

confidence: 99%

Section: Medical Problems In Pregnancymentioning

confidence: 99%

Section: Medical Problems In Pregnancymentioning

confidence: 99%

“…3 Topiramate and valproate are both licensed for migraine treatment but should not be offered to pregnant patient as they are teratogenic.…”

Section: Medical Problems In Pregnancymentioning

confidence: 99%

See 2 more Smart Citations

Medical problems in pregnancy

Sah

Kausar

2017

Clinical Medicine

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“…Seven cases of intravenous rt-PA therapy (0.9 mg/kg) have been reported in 5 reports. 6,22,29,47,52) Endovascular treatment is considered beneficial because it may eliminate the need for thrombolytic agents or allow a decrease in the dose. rt-PA can act on the placenta, leading to premature labor, placental abruption, or fetal death.…”

Section: Ischemic Strokementioning

confidence: 99%

Endovascular Treatment in Pregnancy

Ishii

Miyamoto

2013

Neurol. Med. Chir.(Tokyo)

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There is an increased risk of stroke during pregnancy and the puerperium. Decisions should be made immediately upon transfer to each institution, particularly with respect to when and how to treat the patient. This review highlights the feasibility of endovascular treatment in pregnancy. Most of the pharmaceutical agents and therapeutic devices used in clinical practice can be utilized in pregnant patients. Comprehensive information on the benefits and risks of treatment should be explained to the patient and her family, with particular attention to the safety of the mother and fetus. Radiation exposure to the fetus is also a concern; the hazard can be minimized with optimal protection. Several studies have demonstrated that conventional procedures do not cause serious radiation exposure exceeding the threshold of safety to the fetus. Endovascular therapy can be safely performed for the treatment of acute stroke as in non-pregnant patients with adequate attention to pharmaceutical agents and shielding from radiation. In contrast to therapy for acute stroke, preventive endovascular treatment for asymptomatic lesions remains controversial. Several conditions, such as cerebral aneurysms and arteriovenous malformations, are known to bleed more frequently in pregnancy, but whether the benefits of preventive treatment outweigh the associated risks is unknown. The decision for preventive treatment should be carefully made on a case-by-case basis after extensive discussion with the patient.

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Alteplase Therapy for Acute Ischemic Stroke in Pregnancy: Two Case Reports and a Systematic Review of the Literature

et al. 2019

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Acute ischemic stroke (AIS) during pregnancy is a rare but serious complication. Intravenous alteplase is the only medication approved for hyperacute treatment of AIS; however, it has not been evaluated prospectively in pregnancy. Pregnancy was an exclusion criterion in prospective AIS studies and was only recently removed as a relative contraindication in the 2018 American Heart Association/American Stroke Association Stroke guidelines. Due to the exclusion of pregnant women from randomized controlled trials, the safety of fibrinolytic therapy in pregnant patients is not well established. In this review, we report the use of intravenous alteplase for AIS in two pregnant patients, with temporally associated clinical improvement and without complications to either the mother or fetus. Additionally, we summarize a systematic review of the literature for both intravenous and intra‐arterial alteplase use for AIS in pregnant patients. A total of 31 cases met inclusion criteria for this review of assessment of safety and efficacy of alteplase use in pregnancy. Existing case reports and guidelines support the use of alteplase for AIS in pregnant patients without contraindications.

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Systemic thrombolysis for stroke in pregnancy

Cited by 45 publications

References 5 publications

Medical problems in pregnancy

Medical problems in pregnancy

Endovascular Treatment in Pregnancy

Alteplase Therapy for Acute Ischemic Stroke in Pregnancy: Two Case Reports and a Systematic Review of the Literature

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