Yes, Intravenous Thrombolysis Should Be Administered in Pregnancy When Other Clinical and Imaging Factors Are Favorable

Acute stroke treatment decision-making is a complex process that must be performed quickly. In each case, we must balance the potential benefits with the relevant risks of each therapy to our patients. In this case, the major challenge is determining whether systemic tPA (tissue plasminogen activator) or endovascular treatment is more appropriate in pregnancy.Pregnancy has historically been regarded as a contraindication to IV tPA treatment. Yet tPA is not known to be teratogenic and tPA is also too large a molecule to cross the placenta. To date, 8 cases have been published of IV tPA treatment in pregnancy with only 1 mother suffering a significant uterine bleeding complication and most achieving a good neurological recovery.1,2 Maternal hemorrhagic complications have been reported in 8% with systemic thrombolysis across the spectrum of clinical thromboembolic indications.3 Overall, the IV tPA risk seems reasonably low in pregnancy and not considered an absolute contraindication. This low risk during pregnancy must be balanced against the potential of a disabled outcome without treatment. Although pregnancy is a key determinant of this decision-making process, other clinical and radiological factors should also play a significant role in the art of acute stroke treatment decision-making.These clinical and radiological factors relevant in this particular case …