This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wein, T. H. Articles by Grotta, J. C. Search for Related Content PubMed PubMed Citation Articles by Wein, T. H. Articles by Grotta, J. C. Related Collections Acute Cerebral Infarction Emergency treatment of Stroke Thrombolysis

(Stroke. 2002;33:2506.)
© 2002 American Heart Association, Inc.

Short Communication

Safety of Tissue Plasminogen Activator for Acute Stroke in Menstruating Women

Theodore H. Wein, MD, FRCPC; Susan L. Hickenbottom, MD; Lewis B. Morgenstern, MD; Andrew M. Demchuk, MD, FRCPC James C. Grotta, MD

From the Stroke Program, Department of Neurology, University of Texas at Houston Medical School (T.H.W., S.L.H., L.B.M., A.M.D., J.C.G.), and School of Public Health, University of Texas at Houston Medical School (L.B.M.).

Correspondence to Theodore H. Wein, MD, FRCPC, Division of Neurology, St Mary’s Hospital, McGill University, 3830 Lacombe, Room B-234, Montreal, Quebec, Canada. E-mail twein{at}videotron.ca

Abstract

Background— Menses is a theoretical contraindication to intravenous tissue plasminogen activator (tPA) treatment. We sought to establish the safety of intravenous tPA in the treatment of acute ischemic stroke in women who are actively menstruating.

Summary of Report— We provide a case report and review of the National Institute of Neurological Disorders and Stroke (NINDS) database for women coded as actively menstruating. Nine subjects were coded as actively menstruating in the NINDS trial (4 placebo and 5 in the treatment). One subject in the treatment group who had a 1-year history of dysfunctional uterine bleeding required emergent uterine artery ligation. We also report a case of a woman requiring transfusion after intravenous tPA administration for acute ischemic stroke.

Conclusions— Intravenous tPA may be administered relatively safely in women who are menstruating and should be used with caution in women with a history of dysfunctional uterine bleeding. Potential patients should be advised that they might require transfusion for increased menstrual flow.

Key Words: hemorrhage • menstrual cycle • menstruation • stroke • tissue plasminogen activator • women

This article has been cited by other articles:

				J. Putaala, T. M. Metso, A. J. Metso, E. Makela, E. Haapaniemi, O. Salonen, M. Kaste, and T. Tatlisumak Thrombolysis in Young Adults With Ischemic Stroke Stroke, June 1, 2009; 40(6): 2085 - 2091. [Abstract] [Full Text] [PDF]

				J. De Keyser, Z. Gdovinova, M. Uyttenboogaart, P. C. Vroomen, and G. J. Luijckx Intravenous Alteplase for Stroke: Beyond the Guidelines and in Particular Clinical Situations Stroke, September 1, 2007; 38(9): 2612 - 2618. [Abstract] [Full Text] [PDF]

				A. Aleu, P. Mellado, C. Lichy, M. Kohrmann, and P. D. Schellinger Hemorrhagic Complications After Off-Label Thrombolysis for Ischemic Stroke Stroke, February 1, 2007; 38(2): 417 - 422. [Abstract] [Full Text] [PDF]