tPA in pregnancy

Q: Use of recombinant tissue plasminogen activator (alteplase) in acute ischemic stroke in pregnancy is a (select one)

A) Relative contraindication
B) Absolute contraindication


Answer: A

Alteplase does not cross the placenta but the major concern is various risks associated with hemorrhagic complications in mother and fetus like placental abruption. The American Heart Association/American Stroke Association guidelines designates pregnancy as a relative exclusions. It requires decision on case to case basis taking in confidence all the providers and the family.



References:

1. Murugappan A, Coplin WM, Al-Sadat AN, et al. Thrombolytic therapy of acute ischemic stroke during pregnancy. Neurology 2006; 66:768. 

2. Albers GW, Amarenco P, Easton JD, et al. Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:630S. 

3. Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:581.

4. Tassi R, Acampa M, Marotta G, et al. Systemic thrombolysis for stroke in pregnancy. Am J Emerg Med 2013; 31: 448.e1–3