The Use of Tissue Plasminogen-activator in Pregnancy

Acute stroke during pregnancy is an infrequent but a serious and stressful event, not only for the patient but also for healthcare providers. Concerns about the safety of common radiological tests and thrombolytic therapy to the mother and the unborn fetus often lead to the adoption of a conservative do-no-harm approach during this peculiar situation. Clinical trials of thrombolytic therapy in acute ischemic stroke systematically excluded pregnant patients. According to the labeling, recombinant tissue plasminogen-activator (rt-PA) is classified as pregnancy category C, that is, animal studies have shown an adverse effect on the fetus and there are no adequate well-controlled studies in humans. This led many to taboo the use of rt-PA in pregnant patients. Cited concerns often relate to the possible teratogenic effects of rt-PA; the feared effects of thrombolysis on the placenta culminating in premature labor, placental abruption, or fetal demise; and potential medico-legal issues.Are these fears justified? Yes, but they may be exaggerated. The molecular weight of rt-PA is large (7200 kDa); therefore, it does not cross the placental barrier. Short-term studies in animals have …