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Related Experiment Videos

Thrombolytic therapy in pregnancy.

Georg Leonhardt1, Charly Gaul, Hubert H Nietsch

  • 1Martin-Luther-University Halle-Wittenberg.

Journal of Thrombosis and Thrombolysis
|May 10, 2006
PubMed
Summary

Pregnancy increases clotting risk. Thrombolytic therapy using tissue plasminogen activator (rt-PA) is rarely used but may be safe for pregnant patients with life-threatening blood clots, with similar complication rates to non-pregnant individuals.

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Area of Science:

  • Cardiology
  • Hematology
  • Obstetrics

Background:

  • Pregnancy is a procoagulant state, increasing risks of cardiac valve prosthesis thrombosis, deep venous thrombosis, and pulmonary embolism.
  • Tissue plasminogen activator (rt-PA) is approved for thrombotic events but lacks randomized trial data in pregnancy.
  • Limited case reports exist for rt-PA use during pregnancy.

Observation:

  • Twenty-eight cases of rt-PA thrombolysis in pregnant patients were reviewed.
  • Indications included stroke, cardiac valve prosthesis thrombosis, pulmonary embolism, deep venous thrombosis, and myocardial infarction.
  • Cardiac valve prosthesis thrombosis occurred after switching anticoagulation from warfarin to heparin.

Findings:

  • Maternal complication rates for rt-PA thrombolysis were similar to non-pregnant patients.

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  • Two maternal deaths (7%) and conservative management for three (11%) were reported.
  • Fetal outcomes included 23% mortality, with a likely causal link to rt-PA in 8% of cases; no permanent deficits in live births.

    • Implications:

    • Thrombolytic therapy with rt-PA should not be withheld in pregnant patients with life-threatening thrombembolic disease.
    • rt-PA does not cross the placenta, suggesting a favorable maternal-fetal risk profile.
    • Further research is needed, but current data support rt-PA use in select high-risk pregnancies.