Thrombolytic therapy of acute ischemic stroke during pregnancy

Abstract

The authors report eight pregnant women with acute ischemic stroke treated with thrombolysis (rt-PA [recombinant human tissue plasminogen activator] or urokinase). Seven women recovered. Two extracranial and two asymptomatic intracranial hemorrhages complicated treatment; one woman died of arterial dissection complicating angiography. Three patients had therapeutic abortions, two fetuses were miscarried, and two babies were delivered healthy. Although pregnant women may be treated safely with thrombolytics, risks and benefits to mother and fetus must be carefully weighed.

Acute Revascularization Therapy in Pregnant Patients

“…27) The outcomes of babies were good in four cases with normal delivery and in one with a scheduled cesarean section. One stillbirth (due to chromosome aberration) occurred independent of the revascularization therapy, 31) and the outcome of the seventh was not reported.…”

“…One patient who underwent angioplasty after IV rt-PA therapy suffered arterial dissection resulting in a fatal outcome. 31) Five healthy babies were born by normal delivery and one by cesarean section, and medical abortion at the 1 st trimester was chosen in two cases.…”

ST‐elevation acute myocardial infarction in pregnancy: 2016 update

“…8 Reported complications have included maternal hemorrhage, preterm delivery, fetal loss, spontaneous abortion, placenta abruption, uterine bleeding, and postpartum hemorrhage. 8,48,49 Importantly, given the prevalence of coronary dissection in pregnancy, TT may be harmful, increasing the risk of bleeding and progression of the dissection. 48,49 For these reasons, TT is rarely utilized for AMI treatment in pregnancy.…”

“…8,48,49 Importantly, given the prevalence of coronary dissection in pregnancy, TT may be harmful, increasing the risk of bleeding and progression of the dissection. 48,49 For these reasons, TT is rarely utilized for AMI treatment in pregnancy. Nonetheless, if PCI access for STEMI during pregnancy is not available, TT may be an alternative management strategy.…”

Coronary Artery Disease and Pregnancy

“…(Leohardt et al, 2006) Maternal and fetal outcomes were favourable, but complications, as maternal haemorrhage, fetal loss, abruption placenta, preterm delivery and post partum haemorrhage have been reported in up to 10% and maternal mortality was 1.2 %. (Turrentine et al, 1995) The risk of haemorrhage is highest in the peripartum period (Murugappan et al,. 2006) and given the high incidence of coronary dissection in pregnancy, the use of thrombolytic therapy could lead to haemorrhage and further progression of the dissection.…”