First Reported Case of Tenecteplase for Treatment of Acute Ischemic Stroke in Pregnancy
Jacob Sambursky1, Ali Payan1, Patrick Brown1, Sishir Mannava1
1UT Health Neurosciences
Background:
Tenecteplase (TNK) is Food and Drug Administration approved for reduction of mortality associated with myocardial infarction, but has increasingly been used for treatment of acute ischemic stroke with improved efficacy and similar safety to alteplase. Current guidelines state thrombolytic use in pregnancy should be considered for similar indications as in non-pregnant populations but without increase in significant risk exposure when proper risks and benefits are discussed.
Results:
We present the case of a 30-year-old G2P1 female of 6 weeks gestational age with a history of E-cigarette use who presented 60-minutes after onset of diplopia, right-sided weakness, and right-sided numbness. Examination was significant for mild somnolence, left eye ptosis with vertical gaze and adduction restriction, right nasal labial fold flattening, right upper and lower extremity pronator drift, and decreased sensation to light touch on the right hemibody for a National Institutes of Health Stroke Scale (NIHSS) score of 5. Pregnancy was confirmed by ultrasound with presence of gestational sac and by urine human chorionic gonadotropin testing. Hyperacute magnetic resonance imaging revealed an area of restricted diffusion without correlation on fluid attenuated inverse recovery within the left, medial midbrain and thalamus. TNK was administered thereafter without complication. 24-hour NIHSS was scored a zero with complete resolution of neurologic exam findings. After treatment with TNK, our patient experienced marked improvement of her disabling symptoms. There was no clinical or radiographic evidence of immediate complications with TNK for the mother or fetus.
Conclusions:
We believe this is one of the first reported cases of TNK administration for acute ischemic stroke in pregnancy. As more medical centers transition to TNK for intravenous thrombolysis in acute ischemic stroke, it is important that we continue to report and evaluate safety outcomes for mother and fetus.