Thrombolytic Treatment in High-Risk Pregnancy: A Case Report

Ischemic stroke during pregnancy occurs most often in the third trimester and is potentiated by an increased pro-coagulant state during pregnancy. Precisely this procoagulant state, associated with other thrombophilic phenomena and various risk factors for cardio- and cerebro-vascular pathologies, is the basis of a stroke in the elderly pregnant woman. A 43-year-old woman of 30 weeks pregnant presented within 120 minutes of the sudden onset of left side hemiparesis was given thrombolytic treatment with recombinant tissue plasminogen activator. The risk was extremely high since in the past she had a premature birth for unknown reasons. Our patient improved clinically with no residual deficits. But, being at risk, she was transferred to another hospital where she spontaneously gave birth, after a few days, to a healthy premature baby. It is reasonable to weigh in the benefit of alteplase vs. the risk in this patient group and give treatment for disabling stroke, particularly if there is no access to endovascular treatment.