Catheter-directed thrombolysis for thromboembolic disease during pregnancy: a viable option

Krishnamurthy, Parul; Martin, Chester B.; Kay, Helen H.; Diesner, Jane; Friday, Richard O.; Weber, Charles A.; Droste, Sabine

doi:10.1002/(sici)1520-6661(199901/02)8:1<24::aid-mfm6>3.0.co;2-t

Cited by 36 publications

(10 citation statements)

References 15 publications

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“…Reports of thrombolysis for treating DVT in pregnancy are relatively few and primarily consist of case reports. [24][25][26] A literature search performed by Leonhardt et al 26 included 28 reports of thrombolysis with rt-PA used to treat venous thromboembolism during pregnancy; however, only three of the 28 reports described treatment of DVT, all of which were successful. We believe our series of 13 consecutive patients treated with strategies of thrombus removal for iliofemoral DVT of pregnancy (11 with catheter-directed rt-PA) is the largest report to date.…”

Section: Discussionmentioning

confidence: 99%

Managing iliofemoral deep venous thrombosis of pregnancy with a strategy of thrombus removal is safe and avoids post-thrombotic morbidity

Herrera

Comerota

Thakur

et al. 2014

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Managing iliofemoral deep venous thrombosis of pregnancy with a strategy of thrombus removal is safe and avoids post-thrombotic morbidity

Herrera

Comerota

Thakur

et al. 2014

Journal of Vascular Surgery

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“…Table 3 provides a review of four cases of CDT use in pregnancy. [59][60][61][62] Two cases included mechanical fragmentation of the thrombus along with CDT. 60,61 Alteplase was used in three cases; urokinase was used in one case.…”

Section: Catheter-directed Thrombolysismentioning

confidence: 99%

Thrombolysis for Massive Pulmonary Embolism in Pregnancy

et al. 2017

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Pregnant women are at high risk for venous thromboembolism, including pulmonary embolism (PE), given expected changes in coagulation, fibrinolysis, and venous blood flow. In fact, PE is the leading cause of maternal death in the United States. Nonpregnant patients who develop PE with hypotension or show signs of deterioration after anticoagulation receive thrombolytics as a standard of care. Pregnant women, however, have been excluded from clinical trials with thrombolytics, and all data available in this population are published as case reports or case series. We reviewed all reports of thrombolytics, systemic or catheter directed, used in pregnant patients with massive PE. This article summarizes the risks for thromboembolism in pregnancy, compares and contrasts thrombolytic agents in this setting, and provides a recommendation for management of massive PE in this special population. Overall, reports suggest that the use of these agents is associated with beneficial outcomes and a relatively low risk of complications. The quality of this evidence is low, and clinical judgment is required to assess individual patients for risks versus benefits of thrombolysis.

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“…In the remaining 67 patients with VTE, there were no maternal deaths, three major bleeding events (all associated with streptokinase), two minor bleeding events (one rtPA, one streptokinase), and two deaths in utero (one after mother presented in shock, one after failed surgical embolectomy and subsequent rtPA administration). 25 –28,30 –53…”

Section: Clinical Experience With Thrombolytic Use In Pregnancymentioning

confidence: 99%

The use of thrombolytic therapy in pregnancy

Gartman

2013

Obstet Med

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The relative hypercoagulable state of pregnancy leads to an increased risk of thrombotic complications, of which some may be life-threatening or medically devastating. In the non-pregnant patient, the current guidelines suggest thrombolysis as the primary treatment in acute ischemic stroke, myocardial infarction when percutaneous intervention is unavailable, certain cases of mechanical valve thrombosis, and pulmonary embolism with hemodynamic compromise or shock. Given that clinical trial data regarding thrombolytic use in pregnant women are absent due to exclusion, the goal of this review is to summarize the available published data regarding the use of thrombolytic agents and subsequent outcomes and complications in pregnant women. Overall, the use of thrombolytic agents in pregnancy is associated with a relatively low reported complication rate, especially given the severe medical conditions for which they are indicated. The data would suggest that thrombolysis should be considered for appropriate indications similar to that of non-pregnant patients. However, caution should be exercised when drawing conclusions regarding maternal and fetal safety, given the lack of controlled clinical trials including pregnant women and the nature of the weak evidence level of the cumulative data presented in this review.

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Catheter-directed thrombolysis for thromboembolic disease during pregnancy: a viable option

Cited by 36 publications

References 15 publications

Managing iliofemoral deep venous thrombosis of pregnancy with a strategy of thrombus removal is safe and avoids post-thrombotic morbidity

Managing iliofemoral deep venous thrombosis of pregnancy with a strategy of thrombus removal is safe and avoids post-thrombotic morbidity

Thrombolysis for Massive Pulmonary Embolism in Pregnancy

The use of thrombolytic therapy in pregnancy

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