Abstract 188: Safety of Stroke Thrombolysis During Pregnancy: A Population-Based Analysis

Abstract

Background: Use of tissue plasminogen activator (TPA) during pregnancy is controversial given potential risks of placental and fetal complications. Since knowledge on this topic is limited, we assessed rates of TPA use during pregnancy and the associated patient characteristics and outcomes in a population-based sample of patients. Methods: We used administrative claims data on all discharges from nonfederal emergency departments and acute care hospitals in California, Florida, and New York between 2005 and 2012. Pregnancy was defined as the 40 weeks prior to delivery or abortive outcome. Using a validated ICD-9-CM diagnosis code algorithm, we identified cases of ischemic stroke, as well as cases of intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) since these may represent hemorrhagic transformation of an infarct. We included only the first recorded stroke to focus on incident cases. TPA use was identified by ICD-9-CM procedure code 99.10, which has been validated as 98% specific in this population. Comparisons between groups were made using Fisher’s exact test and t-test or rank-sum test as appropriate. Results: Among 428,564 women with stroke, 599 cases occurred during pregnancy. The rate of TPA use for stroke was significantly lower during pregnancy (1.2%; 95% CI, 0.4-2.4%) than otherwise (3.5%; 95% CI, 3.4-3.6%; P = 0.001). Among pregnant stroke patients, we found few notable differences in the baseline characteristics of the 7 who received TPA versus the 592 who did not: those receiving TPA had higher rates of heart failure (28.6% versus 2.2%; P = 0.01) and pneumonia (14.3% versus 1.2%; P = 0.09) and lower rates of of pre-eclampsia (0.0% versus 29.1%; P = 0.09). There were no notable differences between pregnant stroke patients who did or did not receive TPA in terms of length of hospital stay, discharge disposition, and in-hospital mortality rate. However, we noted a significantly higher rate of abortive pregnancy outcomes during stroke hospitalization in those who received TPA than those who did not (28.6% versus 4.6%; P = 0.04). Conclusion: We found a significantly higher rate of abortive pregnancy outcomes in patients who received TPA. This suggests the need for caution and further research regarding TPA use for stroke in pregnancy.