Thrombolytic therapy of acute ischemic stroke during pregnancy. Neurology. 2006;66(5):768-770.

Thrombolytic therapy of acute ischemic stroke with rt-PA or urokinase can be safely performed in pregnant women, but there are risks that should be considered when making the decision to initiate therapy. The safety and efficacy of thrombolytic therapy for strokes during pregnancy has not been well studied mainly because the problem is so rare. This study describes eight pregnant women who were treated with thrombolytic therapy for acute ischemic stroke. The women ranged from age 21 to 43 years and nearly all were in the first trimester of pregnancy when stroke occurred. The most commonly involved stroke vessels were the middle cerebral arteries. Four of the patients were treated with rt-PA, usually given intravenously, and four patients received urokinase, given locally. The rt-PA was typically given within 3 hours of the stroke, while urokinase was given < 6 hours to > 2 weeks after the stroke. One woman died from arterial dissection during angioplasty, while the others experienced no major complications. Minor complications typically involved hematomas and other hemorrhages. Among the seven surviving women, three underwent therapeutic abortions, two had miscarriages, and two had healthy deliveries. The results of this study indicate that in pregnancy, the risks of stroke must be weighed against the risks of treatment.