Thrombolysis in pregnancy: a literature review

Gomes, Marina Sousa; Guimarães, Mariana; Montenegro, Nuno

doi:10.1080/14767058.2018.1434141

Cited by 68 publications

(37 citation statements)

References 93 publications

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“…Studies have shown that the use of thrombolysis in pregnancy is safe, without any significant increase in maternal deaths or major bleeding events 9–11. However, haemorrhage during parturition or caesarean delivery is a particular risk with fibrinolytic therapy if the patient goes into labour or operative delivery is required, so the benefits of such treatment must be carefully weighed against the risks, particularly in cases of severe pre-eclampsia, when delivery must be expedited.…”

Section: Discussionmentioning

confidence: 99%

Ischaemic stroke and pre-eclampsia in the third trimester of pregnancy: a diagnostic and therapeutic challenge

2019

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A 23-year-old low-risk primiparous patient, who was 35 weeks pregnant, presented in the emergency department after collapsing at home. Her observations showed severe hypertension with proteinuria. On examination, she had left hemiparesis and was aphasic. Fetal monitoring was reassuring. Initial CT did not reveal any evidence of intracranial pathology. She was stabilised and delivered via emergency caesarean section. Subsequent MRI and CT showed an acute right-sided infarct involving the right middle cerebral artery territory, frontal and parietal regions, and increased mass effect. She was transferred to the nearest neurosurgical centre where she was conservatively managed and discharged home 3 weeks later for continuing rehabilitation. She achieved a good recovery.

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Section: Discussionmentioning

confidence: 99%

Ischaemic stroke and pre-eclampsia in the third trimester of pregnancy: a diagnostic and therapeutic challenge

2019

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“…Maintenance of a balance between coagulation and fibrinolysis is of great importance for the perinatal safety of both mothers and infants [16] . A physiologic hypercoagulable state has been demonstrated during pregnancy and the peripartum period [16,17] , which helps to protect women from excessive bleeding during childbirth. Nevertheless, in developed nations, the leading cause of maternal death is thromboembolic disease [18][19][20] .…”

Section: Discussionmentioning

confidence: 99%

Gestational diabetes mellitus is associated with antenatal hypercoagulability and secondary hyperfibrinolysis: a case control study of Chinese women

Liu

Sun

Tao

et al. 2019

Preprint

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Background : To determine the relationship between gestational diabetes mellitus (GDM) and coagulation/fibrinolysis disorders in antenatal Chinese women . Methods: Case control study. Fifty women had GDM and 132 did not (the NGDM group). Maternal plasma biochemistry and previous medical history were collected from perinatal health records. Antenatal coagulation/fibrinolysis were assessed using thromboelastography and traditional measures, then the relationship between coagulation/fibrinolysis and GDM was analyzed by multiple regression analysis. Results: GDM was significantly associated with higher activated partial thromboplastin time (odds ratio [OR] 1.5, 95% confidence interval [CI] 0.4–2.6); fibrinogen (OR 0.3, 95% CI 0.1–0.6); and percentage reduction in clot lysis after 30 min (OR 1.2, 95% CI 0.2–2.2), after adjustment for potential confounding factors. Both the intraoperative (238.2±71.0 ml vs . 286.0±102.4 ml, P =0.003) and 24-hour after surgery (270.7±99.8 ml vs . 314.7±131.1 ml, P =0.033) blood loss were lower and the prevalence of cesarean delivery (56.0% vs . 37.9%, P =0.027) was higher in the GDM group. There were no significant differences in the prevalence of maternal thrombotic events or maternal body mass before delivery. Conclusions: GDM is significantly associated with hypercoagulability and secondary hyperfibrinolysis in these antenatal Chinese women.

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“…Moreover, the limited suggestions provided by the PE guidelines have primarily been made based on pooled and analyzed data obtained from case reports; therefore, clinicians should exercise caution when drawing conclusions in actual clinical situations. Gomes et al [ 8 ] studied 65 articles describing the use of thrombolytic agents during pregnancy and maternity and reported that the complication rate of thrombolytic agent use in pregnant women appeared to be the same as that in nonpregnant women. Twenty-five women suffering with PE during the gestational period were included in this review.…”

Section: Discussionmentioning

confidence: 99%

Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida

et al. 2018

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Rational:Thrombolysis in primigravida with hemodynamic instability is controversial, especially treatment with low-dosage recombinant tissue plasminogen activator (rtPA), and related studies are extremely rare. Here, we report the case of a 26-year-old primigravida diagnosed with an acute massive pulmonary embolism (PE) that prompted initiation of thrombolysis with low-dose alteplase.Patient concerns:The patient was admitted to the Emergency Department with chief complaints of a sudden onset of extremely dyspnea, chest tightness, and confusion over a 6-hour period. She was found to have significant dilation of her right ventricle, moderate pulmonary arterial hypotension, as shown by transthoracic echocardiography, and a typical S1-Q3-T3 pattern, as shown by electrocardiogram (ECG).Diagnosis:Acute massive PE in primigravida.Intervention:The patient underwent intravenous thrombolysis with a half dose of alteplase.Outcomes:The fetus lived through this severe event during the mother's stay in the Intensive Care Unit; however, surgical abortion was unexpectedly proposed due to long-term hypoxia and high-risk of relapse and exacerbation and was performed successfully after the agreement of her kin. The patient recovered gradually, and results of her laboratory tests and postsurgical, repeated contrast-enhanced computed tomography had normalized by her 3-month follow-up.Lessons:Administration of low-dosage alteplase in primigravida with hemodynamic instability is extremely rare and controversial; however, our case suggests that this treatment strategy is relatively safe and feasible. In addition, nonradiometric examination played a major role in the diagnosis of PE in this patient. Because radiation use is contraindicated during pregnancy, these examinations could be the first choice for pregnant patients with suspected PE.

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Thrombolysis in pregnancy: a literature review

Cited by 68 publications

References 93 publications

Ischaemic stroke and pre-eclampsia in the third trimester of pregnancy: a diagnostic and therapeutic challenge

Ischaemic stroke and pre-eclampsia in the third trimester of pregnancy: a diagnostic and therapeutic challenge

Gestational diabetes mellitus is associated with antenatal hypercoagulability and secondary hyperfibrinolysis: a case control study of Chinese women

Successful low-dosage thrombolysis of massive pulmonary embolism in primigravida

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