Systematic review assesses thrombolytic safety for stroke in pregnancy

A systematic review and Bayesian aggregated case series analyzed 216 pregnant patients who received thrombolytics, including 85 treated for ischemic stroke, to evaluate maternal and fetal safety outcomes. The review found higher rates of miscarriage (12.4% higher) and stillbirth (5.9% higher) compared with general pregnant population rates, with 6 of 32 fetal deaths deemed likely causally related to thrombolytics, while symptomatic intracerebral hemorrhage rates in mothers were similar to young, nonpregnant thrombolysis recipients. The authors state their findings broadly support thrombolytic use in otherwise-eligible pregnant patients but note results should be interpreted cautiously given difficulty distinguishing drug effects from disease effects.

Most relevant for: Pregnant patients presenting with acute ischemic stroke who are otherwise eligible for thrombolytic therapy.

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