Maternal and Fetal Safety Outcomes of Thrombolytics for Ischemic Stroke in Pregnancy: A Systematic Review and Aggregated Case Series.

In 30 seconds

This systematic review and Bayesian aggregated case series examined maternal and fetal outcomes after thrombolytic treatment during pregnancy. It included 123 studies reporting 216 treated patients, including 85 with ischemic stroke. Six of 32 fetal deaths were judged likely causally related to thrombolytics, three among patients treated for stroke. Compared with published general-population rates, miscarriage risk was 12.4% higher (95% credible interval [CrI]: 2.6%, 23.2%) and stillbirth risk was 5.9% higher (95% CrI: 1.6%, 12.7%). Symptomatic intracerebral hemorrhage rates were similar to those in young, nonpregnant patients receiving thrombolytics.

Key findings

• Among 32 fetal deaths, six were considered likely causally related to thrombolytics, including three in patients treated for stroke.
• Miscarriage risk was 12.4% higher (95% CrI: 2.6%, 23.2%) than published general-population rates.
• Stillbirth risk was 5.9% higher (95% CrI: 1.6%, 12.7%) than published general-population rates.
• Symptomatic intracerebral hemorrhage risk difference versus young, nonpregnant thrombolysis recipients was -0.4% (95% CrI: -0.8%, 2.7%).

Why it matters

Pregnancy-specific safety evidence for thrombolysis is limited, and these findings help frame maternal and fetal risks when considering treatment for an otherwise eligible patient. The review found no signal of increased maternal symptomatic intracerebral hemorrhage, while fetal outcomes warrant careful interpretation because the underlying disease and treatment effects may be difficult to separate.

What to keep in mind

The evidence consists of published cases, and the authors note that fetal complications may reflect the underlying disease rather than thrombolysis. Elective termination and spontaneous abortion were grouped together, limiting attribution of fetal outcomes.