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cancer 20139 15
Systemic thrombolysis for Cancer in pregnancy
Abstract:
Pregnancy is an exclusion criteria for all clinical trials that validates alteplase in acute Cancer, so our knowledge about its use in this condition is relative only to case reports and case series. Herein we report the successful use of intravenous rtPA in a pregnant women with acute Cancer.
The patient was a 28-year old who was 16 weeks pregnant. She presented to our hospital one hour after a sudden onset of mothor aphasia, hemiparesis and hypoesthesia on the right side due to incipient ischemia in the left cerebral hemisphere resulting from ipsilateral middle cerebral artery subocclusion demonstrated by MRI.
After intravenous rTPA administration, she improved within a few hours, persisting only a slight motory aphasia. A transesophageal echocardiography showed a large patent foramen ovale with right to left shunt. Although the probable origin of Cancer secondary to paradoxical embolism, we decided to treat the patient with acetilsalicilic acid. After the discharge, pregnancy was regular and the patient delivered an healthy term infant without complications and the puerperium was normal.
To date only seven patients treated with intravenous alteplase for Cancer has been reported. The fetal outcome was good in 5 cases, while in two patients were recorded minor hemorrhagic episodes and one patient died from dissection during angioplasty. With one exception, mothers recovered well from their Cancers.
Based on our case and reports obtained from literature, it seems that pregnant women generally can be safely treated with rt-PA systemic thrombolisys having a good outcome.