tPA in pregnancy

Q: Alteplase (tPA) in pregnancy is? (select one)

A) Relative contraindication
B) Absolute contraindication


Answer: A

Alteplase (tPA) does not cross the placenta, but the risk exists due to hemorrhagic complications, which may lead to added complications in a pregnant patient with premature labor, placental abruption, or fetal demise. But in pregnant patients with life-threatening stroke, strong consideration should be given to tPA therapy.

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#OB-Gyn


References:

1. Leonhardt G, Gaul C, Nietsch HH, et al. Thrombolytic therapy in pregnancy. J Thromb Thrombolysis 2006; 21:271. 

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

3.  Demchuk AM. Yes, intravenous thrombolysis should be administered in pregnancy when other clinical and imaging factors are favorable. Stroke 2013; 44:864. 

4.  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.