Thrombolytic Therapy of Acute Ischemic Stroke during Early Pregnancy

Thrombolytic treatment (recombinant tissue plasminogen activator [rt-PA]) has established efficacy in acute ischemic stroke, but pregnancy has been an exclusion criterion for all clinical trials that validated alteplase in acute stroke, so our knowledge about its use in this condition is limited. Herein we report the successful use of intravenous rt-PA thrombolysis, uncomplicated by neither hemorrhage development nor other complication in a woman who was 13 weeks pregnant with acute ischemic stroke. The brain magnetic resonance imaging diffusion-weighted sequences showed increased signal in the territory of the left middle cerebral artery. Our case had a good maternal and fetal outcome, and advocates that the use of thrombolytics may be feasible in pregnant patients and help to avoid residual neurologic deficits. A summary of published cases in the early aspect of pregnancy and outcomes is presented. Risks and benefits to mother and fetus must be weighted up, but intravenous thrombolysis must not be considered as an absolute contraindication, even in early pregnancy.