Clot Removal Procedure Seems Safe for Pregnant Stroke Patients
Removing a blood clot in the brain physically is a safe and effective treatment for pregnant women with stroke, a new study suggests.
Strokes during pregnancy are rare, but the risk increases during pregnancy and for up to 12 weeks after childbirth, or after childbirth.
The most common type is ischemic stroke, where a clot blocks blood flow to the brain. Mechanical thrombectomy – where a surgeon threads a catheter through an artery to remove a large clot – became standard treatment in 2015 after a series of landmark studies.
“Unfortunately, pregnant and postpartum patients are routinely excluded from many clinical trials,” said Dr. Fawaz Al-Mufti, lead author of the new study, published Sept. 20 in the journal American Heart Association. Stroke.
The rarity of these strokes is also a challenge for researchers, with around 1.5 to 67.1 strokes per 100,000 deliveries – as low as 0.0015% of pregnant women.
So Al-Mufti, associate president of neurology for research at New York Medical College in Valhalla, and his team have turned to big data. They used a database called the National Inpatient Sample to identify 52,825 women hospitalized for stroke between 2012 and 2018. Of these women, 4,590 were pregnant or had just given birth. And among these women, 180 had been treated by mechanical thrombectomy.
The study first compared these 180 pregnant or postpartum women with 48,055 non-pregnant women who also underwent mechanical thrombectomy. After the procedure, the pregnant group was less likely to have dangerous bleeding inside the skull, called intracranial hemorrhage.
Pregnant / postpartum women also performed better overall after thrombectomy. Half had moderate to severe disability upon discharge, compared with nearly three-quarters of the group who were not pregnant. None of the pregnant / postpartum women died in hospital; 14% of the non-pregnant group did so.
Pregnant women tended to be younger, with an average age of 33, compared to 71 for the larger group of non-pregnant women. But pregnant women were more likely to have had more serious strokes.
The study also compared pregnant women who underwent mechanical thrombectomy with 4,410 pregnant or postpartum women who underwent medical treatment for their stroke, such as drugs to dissolve clots, Al-Mufti said. . That analysis involved selectively matching women whose situations were as similar as possible, although the researchers said they lacked data on race.
In this comparison, the two groups were similar in their rates of intracranial hemorrhage and postnatal complications and in their ability to function when they left the hospital. Complications of pregnancy were less frequent after mechanical thrombectomy than after medical management (44% vs. 64%) and no member of the thrombectomy group suffered a miscarriage.
The mechanical thrombectomy group had a higher rate of dangerous blood clots in the large veins, often in the legs, called deep vein thrombosis, or in the lungs, called pulmonary embolism.
Al-Mufti said this could be because these patients are staying in hospital longer and being immobile can lead to such clotting. Or it could be that women in this group are predisposed to intense clotting and more severe strokes, he said. “I don’t believe there was a causation here, just a correlation.”
Dr Sadiya Khan, assistant professor of medicine and preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, said the study shows the importance of research on pregnant and postpartum women.
Khan, who was not in the study, said pregnancy puts a strain on women’s bodies, making them more prone to blood clots and inflammation, which could lead to strokes. But doctors don’t always have solid data to guide treatment because “it can be risky to include pregnant women in research due to concerns about the safety of both the woman and the fetus,” he said. she declared. “But it is also unfair to systematically exclude them from all research when they need this data.”
The study had limitations, Khan said. Stroke rates differ across racial and ethnic groups – stroke risk is higher, for example, in blacks than in whites – so studies should include race and other social determinants of health when ‘they are available. Al-Mufti said the study contained racial data but could not confidently control it in their analysis because some of the racial entries were missing.
Khan said it would also be helpful to see data on conditions of increased blood pressure such as preeclampsia that may increase a pregnant woman’s risk of stroke.
Limitations aside, she said, the study offers useful indications that for pregnant and postpartum women, “it would be prudent to perform a mechanical thrombectomy, which may provide the best results for women. long term”.
The researchers recognized that different types of studies would be needed to validate their results, but the rarity of the problem makes these types of studies unlikely.
Al-Mufti said the study suggests that pregnant stroke patients should be carefully monitored for blood clots as they recover. And overall, it tells doctors not to be wary of using mechanical thrombectomy in pregnant women. “On the contrary, endovascular therapy can be very effective and very useful in this patient population. ”
How Does Pregnancy Affect Stroke Risk in Older and Younger Women?
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