Stroke treatment: Beyond the three-hour window and in the pregnant patient

Annals of the New York Academy of Sciences

Volumn 1142, Issue , 2008, Pages 159-178

  Cronin, C A ^a   Weisman, C J ^b   Llinas, R H ^a,c  

^a JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE   (United States)

^b SINAI HOSPITAL OF BALTIMORE   (United States)

^c JOHNS HOPKINS BAYVIEW MEDICAL CENTER   (United States)

Author keywords

Pregnancy; Stroke; Thrombolysis; Treatment

Indexed keywords

ACETYLSALICYLIC ACID; ALTEPLASE; CANDESARTAN HEXETIL; CLOPIDOGREL; DANAPAROID; DESMOTEPLASE; DIPYRIDAMOLE; ENOXAPARIN; GLUCOSE; HEPARIN; INSULIN; LABETALOL; LISINOPRIL; LOW MOLECULAR WEIGHT HEPARIN; LOXOPROFEN; PARACETAMOL; PLACEBO; PROUROKINASE; STREPTOKINASE; TISSUE PLASMINOGEN ACTIVATOR; UROKINASE; WARFARIN;

ANTICOAGULANT THERAPY; ANTIHYPERTENSIVE THERAPY; BLEEDING; BODY TEMPERATURE; BRAIN DECOMPRESSION; BRAIN HEMORRHAGE; BRAIN SURGERY; CEREBROVASCULAR ACCIDENT; CHRONOTHERAPY; CLINICAL FEATURE; CLINICAL TRIAL; COMBINATION CHEMOTHERAPY; CONTROLLED CLINICAL TRIAL; DEEP VEIN THROMBOSIS; DIABETES MELLITUS; DIASTOLIC BLOOD PRESSURE; DRUG DOSE COMPARISON; DRUG DOSE ESCALATION; DRUG SUBSTITUTION; DRUG WITHDRAWAL; DUCTUS ARTERIOSUS OBLITERATION; EMERGENCY WARD; EPIDURAL HEMATOMA; FETAL HEMORRHAGE; FETUS DEATH; FEVER; HEALTH CARE ORGANIZATION; HEALTH CARE SYSTEM; HEART ATRIUM FIBRILLATION; HEMORRHAGIC STROKE; HEPARIN INDUCED THROMBOCYTOPENIA; HIGH RISK PREGNANCY; HOSPITAL ADMISSION; HUMAN; HYPERTENSION; INDUCED HYPOTHERMIA; INTENSIVE CARE; INTRAUTERINE GROWTH RETARDATION; LOW DRUG DOSE; MATERNAL MORTALITY; MICROEMBOLISM; MIDDLE CEREBRAL ARTERY OCCLUSION; MONOTHERAPY; NEUROIMAGING; OCCLUSIVE CEREBROVASCULAR DISEASE; OSTEOPENIA; OSTEOPOROSIS; PHYSIOTHERAPY; PREECLAMPSIA; PREGNANT WOMAN; RECANALIZATION; REVIEW; RISK ASSESSMENT; RISK BENEFIT ANALYSIS; SIDE EFFECT; STROKE; STROKE PATIENT; SYSTEMIC DISEASE; SYSTOLIC BLOOD PRESSURE; TERATOGENICITY; THERAPY DELAY; THROMBOCYTOPENIA; THROMBOPHILIA; THROMBOSIS; THROMBOSIS PREVENTION; TRANSIENT ISCHEMIC ATTACK; UNSPECIFIED SIDE EFFECT;

EID: 55049097140     PISSN: 00778923     EISSN: 17496632     Source Type: Book Series    
DOI: 10.1196/annals.1444.013     Document Type: Review

References (129)

1. Marler, J.R. 1995. Tissue plasminogen activator for acute ischemic stroke. N. Engl. J. Med. 333 : 1581 1587.
2. Candelise, L. 1995. Randomised controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischaemic stroke. Lancet 346 : 1509 1514.
3. Hommel, M., C. Cornu, F. Boutitie & J.P. Boissel. 1996. Thrombolytic therapy with streptokinase in acute ischemic stroke. N. Engl. J. Med. 335 : 145 150.
4. Donnan, G.A., S.M. Davis & B.R. Chambers. 1996. Australian streptokinase trial (ASK). JAMA. 276 : 963 966.
5. Hacke, W., M. Kaste, C. Fieschi, et al. 1995. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Acute Stroke Study (ECASS). JAMA 274 : 1017 1025.
6. Hacke, W., M. Kaste, C. Fieschi, et al. 1998. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 352 : 1245 1251.
7. Clark, W.M., S. Wissman, G.W. Albers, et al. 1999. Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset the ATLANTIS study: a randomized controlled trial. JAMA 282 : 2019 2026.
8. Clark, W.M., G.W. Albers, K.P. Madden & S. Hamilton. 2000. The rtPA (alteplase) 0- to 6-hour acute stroke trial, part A (A0276g): results of a double-blind, placebo-controlled, multicenter study. Stroke 31 : 811 816.
9. 2004. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 363 : 768 774.
10. Larrue, V., R. Von Kummer, A. Müller & E. Bluhmki. 2001. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian acute stroke study (ECASS II). Stroke 32 : 438 441.
11. Albers, G.W., V.N. Thijs, L. Wechsler, et al. 2006. Magnetic resonance imaging profiles predict clinical response to early reperfusion: the diffusion and perfusion imaging evaluation for understanding stroke evolution (DEFUSE) study. Ann. Neurol. 60 : 508 517.
12. Thomalla, G., C. Schwark, J. Sobesky, et al. 2006. Outcome and symptomatic bleeding complications of intravenous thrombolysis within 6 hours in MRI-selected stroke patients: comparison of a german multicenter study with the pooled data of ATLANTIS, ECASS, and NINDS tPA trials. Stroke 37 : 852 858.
13. Schellinger, P.D., G. Thomalla, J. Fiehler, et al. 2007. MRI-based and CT-based thrombolytic therapy in acute stroke within and beyond established time windows: an analysis of 1210 patients. Stroke 38 : 2640 2645.
14. Davis, S.M., G.A. Donnan, M.W. Parsons, et al. 2008. Effects of alteplase beyond 3 h after stroke in the echoplanar imaging thrombolytic evaluation trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol. 7 : 299 309.
15. Hacke, W., G. Albers, Y. Al-Rawi, et al. 2005. The desmoteplase in acute ischemic stroke trial (DIAS): a phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke 36 : 66 73.
16. Furlan, A.J., D. Eyding, G.W. Albers, et al. 2006. Dose escalation of desmoteplase for acute ischemic stroke (DEDAS): evidence of safety and efficacy 3 to 9 hours after stroke onset. Stroke 37 : 1227 1231.
17. Furlan, A., R. Higashida, L. Wechsler, et al. 1999. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. JAMA 282 : 2003 2011.
18. Barber, P.A., A.M. Demchuk, J. Zhang & A.M. Buchan. 2000. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 355 : 1670 1674.
19. Shaltoni, H.M., K.C. Albright, N.R. Gonzales, et al. 2007. Is intra-arterial thrombolysis safe after full-dose intravenous recombinant tissue plasminogen activator for acute ischemic stroke? Stroke 38 : 80 84.
20. Broderick, J. 2004. Combined intravenous and intra-arterial recanalization for acute ischemic stroke: the interventional management of stroke study. Stroke 35 : 904 911.
21. Broderick, J.P. 2007. The interventional management of stroke (IMS) II study. Stroke 38 : 2127 2135.
22. Brekenfeld, C., G. Schroth, M. El-Koussy, et al. 2008. Mechanical thromboembolectomy for acute ischemic stroke: comparison of the catch thrombectomy device and the Merci Retriever in vivo. Stroke 39 : 1213 1219.
23. Smith, W.S., G. Sung, J. Saver, et al. 2008. Mechanical thrombectomy for acute ischemic stroke: final results of the multi MERCI trial. Stroke 39 : 1205 1212.
24. Qureshi, A.I., J.I. Suarez, A.M. Yahia, et al. 2003. Timing of neurologic deterioration in massive middle cerebral artery infarction: a multicenter review. Crit. Care Med. 31 : 272 277.
25. Qureshi, A.I., R.G. Geocadin, J.I. Suarez & J.A. Ulatowski. 2000. Long-term outcome after medical reversal of transtentorial herniation in patients with supratentorial mass lesions. Crit. Care Med. 28 : 1556 1564.
26. Koenig, M.A., M. Bryan, J.L. Lewin III., et al. 2008. Reversal of transtentorial herniation with hypertonic saline. Neurology 70 (13 part 1 1023 1029.
27. Vahedi, K., J. Hofmeijer, E. Juettler, et al. 2007. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 6 : 215 222.
28. Sandercock, P.A.G. 1997. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke. Lancet 349 : 1569 1581.
29. Chen, Z. 1997. CAST: randomised placebo-controlled trial of early aspirin use in 20,000 patients with acute ischaemic stroke. Lancet 349 : 1641 1649.
30. Chen, Z., P. Sandercock, H. Pan, et al. 2000. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40 000 randomized patients from the chinese acute stroke trial and the international stroke trial. Stroke 31 : 1240 1249.
31. Lowenthal, A., L. Dom, E. Moens, et al. 1990. European stroke prevention study. Stroke 21 : 1122 1130.
32. Diener, H.C., L. Cunha, C. Forbes, et al. 1996. European stroke prevention study 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J. Neurol. Sci. 143 : 1 13.
33. ESPRIT Study Group. 2006. Aspirin plus dipyridamole versus aspirin alone after cerebral ischaemia of arterial origin (ESPRIT): randomised controlled trial. Lancet 367 : 1665 1673.
34. Gent, M. 1996. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348 : 1329 1339.
35. Markus, H.S., D.W. Droste, M. Kaps, et al. 2005. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using Doppler embolic signal detection: the clopidogrel and aspirin for reduction of emboli in symptomatic carotid stenosis (CARESS) trial. Circulation 111 : 2233 2240.
36. Kennedy, J., M.D. Hill, K.J. Ryckborst, et al. 2007. Fast assessment of stroke and transient ischaemic attack to prevent early recurrence (FASTER): a randomised controlled pilot trial. Lancet Neurol. 6 : 961 969.
37. Diener, P.H., P.J. Bogousslavsky, P.L.M. Brass, et al. 2004. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 364 : 331 337.
38. Leizorovicz, A., G. Simonneau, H. Decousus & J.P. Boissel. 1994. Comparison of efficacy and safety of low molecular weight heparins and unfractionated heparin in initial treatment of deep venous thrombosis: a meta-analysis. Br. Med. J. 309 : 299 304.
39. Baker, B.A. & M.D. Adelman. 1998. Low-molecular-weight heparin versus unfractionated heparin for unstable coronary disease. N. Engl. J. Med. 338 : 130.
40. Adams, H.P. Jr. 1998. Low molecular weight heparinoid, ORG 10172 (danaparoid), and outcome after acute ischemic stroke: a randomized controlled trial. JAMA 279 : 1265 1272.
41. Van Latum, J.C., P.C. Vermeulen, A. Den Ouden, et al. 1993. Secondary prevention in non-rheumatic atrial fibrillation after transient ischaemic attack or minor stroke. Lancet 342 : 1255 1262.
42. Saxena, R., S. Lewis, E. Berge, et al. 2001. Risk of early death and recurrent stroke and effect of heparin in 3169 patients with acute ischemic stroke and atrial fibrillation in the international stroke trial. Stroke 32 : 2333 2337.
43. Adams, H.P., Jr., B.H. Bendixen, E. Leira, et al. 1999. Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery: a report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST). Neurology 53 : 122 125.
44. Benninger, D.H., D. Georgiadis, C. Kremer, et al. 2004. Mechanism of ischemic infarct in spontaneous carotid dissection. Stroke 35 : 482 485.
45. Dreier, J.P., F. Lürtzing, M. Kappmeier, et al. 2004. Delayed occlusion after internal carotid artery dissection under heparin. Cerebrovasc. Dis. 18 : 296 303.
46. Lawes, C.M.M., D.A. Bennett, V.L. Feigin & A. Rodgers. 2004. Blood pressure and stroke: an overview of published reviews. Stroke 35 : 776 785.
47. Yong, M. & M. Kaste. 2008. Association of characteristics of blood pressure profiles and stroke outcomes in the ECASS-II trial. Stroke 39 : 366 372.
48. Yong, M., H. Diener, M. Kaste & J. Mau. 2005. Characteristics of blood pressure profiles as predictors of long-term outcome after acute ischemic stroke. Stroke 36 : 2619 2625.
49. Vemmos, K.N., G. Tsivgoulis, K. Spengos, et al. 2004. U-shaped relationship between mortality and admission blood pressure in patients with acute stroke. J. Intern. Med. 255 : 257 265.
50. Leonardi-Bee, J., P.M.W. Bath, S.J. Phillips & P.A.G. Sandercock. 2002. Blood pressure and clinical outcomes in the international stroke trial. Stroke 33 : 1315 1320.
51. Castillo, J., R. Leira, M.M. García, et al. 2004. Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor stroke outcome. Stroke 35 : 520 527.
52. Jørgensen, H.S., H. Nakayama, H.O. Raaschou & T.S. Olsen. 1994. Effect of blood pressure and diabetes on stroke in progression. Lancet 344 : 156 159.
53. Oliveira-Filho, J., S.C.S. Silva, C.C. Trabuco, et al. 2003. Detrimental effect of blood pressure reduction in the first 24 hours of acute stroke onset. Neurology 61 : 1047 1051.
54. Castillo, J., R. Leira, M.M. García, et al. 2004. Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor stroke outcome. Stroke 35 : 520 527.
55. Adams, H.P. Jr., G. Del Zoppo, M.J. Alberts, et al. 2007. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 38 : 1655 1711.
56. Schrader, J., S. Lüders, A. Kulschewski, et al. 2003. The ACCESS study: evaluation of acute candesartan cilexetil therapy in stroke survivors. Stroke 34 : 1699 1703.
57. Potter, J.F. 2005. CHHIPS (controlling hypertension and hypotension immediately post-stroke) pilot trial: rationale and design. J. Hypertens. 23 : 649 655.
58. Wityk, R.J. 2007. Blood pressure augmentation in acute ischemic stroke. J. Neurol. Sci. 261 : 63 73.
59. Rordorf, G., W.J. Koroshetz, M.A. Ezzeddine, et al. 2001. A pilot study of drug-induced hypertension for treatment of acute stroke. Neurology 56 : 1210 1213.
60. Hillis, A.E., J.A. Ulatowski, P.B. Barker, et al. 2003. A pilot randomized trial of induced blood pressure elevation: effects on function and focal perfusion in acute and subacute stroke. Cerebrovasc. Dis. 16 : 236 246.
61. Hillis, A.E., P.B. Barker, N.J. Beauchamp, et al. 2001. Restoring blood pressure reperfused Wernicke's area and improved language. Neurology 56 : 670 672.
62. Hoesch, R.E. & R.G. Geocadin. 2007. Therapeutic hypothermia for global and focal ischemic brain injury - A cool way to improve neurologic outcomes. Neurologist 13 : 331 342.
63. Van Zanten, A.R.H. & K.H. Polderman. 2005. Early induction of hypothermia: will sooner be better? Crit. Care Med. 33 : 1449 1452.
64. Kasner, S.E., T. Wein, P. Piriyawat, et al. 2002. Acetaminophen for altering body temperature in acute stroke: a randomized clinical trial. Stroke 33 : 130 134.
65. De Georgia, M.A., D.W. Krieger, A. Abou-Chebl, et al. 2004. Cooling for acute ischemic brain damage (COOL AID): a feasibility trial of endovascular cooling. Neurology 63 : 312 317.
66. Moriwaki, H., K. Miyashita, K. Nagatsuka, K. Konaka, B. Hyon, N. Hiroaki et al. 2008. Feasibility and safety of very mild hypothermia using non-steroidal anti-inflammatory drugs in acute embolic stroke: a case controlled study. Stroke abstracts, International Stroke Symposium. 39 : 594.
67. De Courten-Myers, G., R.E. Myers & L. Schoolfield. 1988. Hyperglycemia enlarges infarct size in cerebrovascular occlusion in cats. Stroke 19 : 623 630.
68. Cronberg, T., A. Rytter, F. Asztély, et al. 2004. Glucose but not lactate in combination with acidosis aggravates ischemic neuronal death in vitro. Stroke 35 : 753 757.
69. Scott, J.F., G.M. Robinson, J.M. French, et al. 1999. Prevalence of admission hyperglycaemia across clinical subtypes of acute stroke. Lancet 353 : 376 377.
70. Demchuk, A.M., D. Tanne, M.D. Hill, et al. 2001. Predictors of good outcome after intravenous tPA for acute ischemic stroke. Neurology 57 : 474 480.
71. Saposnik, G., B. Young, B. Silver, et al. 2004. Lack of improvement in patients with acute stroke after treatment with thrombolytic therapy: predictors and association with outcome. JAMA 292 : 1839 1844.
72. Capes, S.E., D. Hunt, K. Malmberg, et al. 2001. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 32 : 2426 2432.
73. Gray, C.S., A.J. Hildreth, G.K.M.M. Alberti & J.E. O'Connell. 2004. Poststroke hyperglycemia: natural history and immediate management. Stroke 35 : 122 126.
74. Walters, M.R., C.J. Weir & K.R. Lees. 2006. A randomised, controlled pilot study to investigate the potential benefit of intervention with insulin in hyperglycaemic acute ischaemic stroke patients. Cerebrovasc. Dis. 22 : 116 122.
75. Bruno, A., T.A. Kent, B.M. Coull, et al. 2008. Treatment of hyperglycemia in ischemic stroke (THIS): a randomized pilot trial. Stroke 39 : 384 389.
76. Gray, C.S., A.J. Hildreth, P.A. Sandercock, et al. 2007. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK glucose insulin in stroke trial (GIST-UK). Lancet Neurol. 6 : 397 406.
77. Kelly, J., A. Rudd, R. Lewis & B.J. Hunt. 2001. Venous thromboembolism after acute stroke. Stroke 32 : 262 267.
78. Sandercock, P.A.G., A.G.M. Van Den Belt, R.I. Lindley & J. Slattery. 1993. Antithrombotic therapy in acute ischaemic stroke: an overview of the completed randomised trials. J. Neurol. Neurosurg. Psychiatry 56 : 17 25.
79. Martino, R., N. Foley, S. Bhogal, et al. 2005. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 36 : 2756 2763.
80. Aslanyan, S., C.J. Weir, H. Diener, et al. 2004. Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN international trial. Eur. J. Neurol. 11 : 49 53.
81. Chamorro, A., J.P. Horcajada, V. Obach, et al. 2005. The early systemic prophylaxis of infection after stroke study: a randomized clinical trial. Stroke 36 : 1495 2000.
82. Pollock, A., G. Baer, P. Langhorne & V. Pomeroy. 2008. Physiotherapy treatment approaches for stroke. Stroke 39 : 519 520.
83. Bernhardt, J., H. Dewey, A. Thrift, et al. 2008. A very early rehabilitation trial for stroke (AVERT): phase II safety and feasibility. Stroke 39 : 390 396.
84. Imperiale, T.F. & A.S. Petrulis. 1991. A meta-analysis of low-dose aspirin for the prevention of pregnancy-induced hypertensive disease. JAMA 266 : 260 264.
85. Beroyz, G., R. Casale, A. Farreiros, et al. 1994. CLASP: a randomised trial of low-dose aspirin for the prevention and treatment of pre-eclampsia among 9364 pregnant women. Lancet 343 : 619 629.
86. Rai, R., H. Cohen, M. Dave & L. Regan. 1997. Randomised controlled trial of aspirin and aspirin plus heparin in pregnant women with recurrent miscarriage associated with phospholipid antibodies (or antiphospholipid antibodies). Br. Med. J. 314 : 253 257.
87. Kutteh, W.H. 1996. Antiphospholipid antibody-associated recurrent pregnancy loss: treatment with heparin and low-dose aspirin is superior to low-dose aspirin alone. Am. J. Obstet. Gynecol. 174 : 1584 1589.
88. Bates, S.M., I.A. Greer, J. Hirsh & J.S. Ginsberg. 2004. Use of antithrombotic agents during pregnancy: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126 (3 suppl. 627S 644S.
89. Atallah, A.N. 1996. ECPPA: randomised trial of low dose aspirin for the prevention of maternal and fetal complications in high risk pregnant women. Br. J. Obstet. Gynaecol. 103 : 39 47.
90. Flessa, H.C., A.B. Kapstrom, H.I. Glueck & J.J. Will. 1965. Placental transport of heparin. Am. J. Obstet. Gynecol. 93 : 570 573.
91. Forestier, F., F. Daffos & M. Capella-Pavlovsky. 1984. Low molecular weight heparin (PK 10169) does not cross the placenta during the second trimester of pregnancy study by direct fetal blood sampling under ultrasound. Thromb. Res. 34 : 557 560.
92. Forestier, F., F. Daffos, M. Rainaut & F. Toulemonde. 1987. Low molecular weight heparin (CY 216) does not cross the placenta during the third trimester of pregnancy. Thromb. Haemost. 57 : 234.
93. Greer, I.A. & C. Nelson-Piercy. 2005. Low-molecular-weight heparins for thromboprophylaxis and treatment of venous thromboembolism in pregnancy: a systematic review of safety and efficacy. Blood 106 : 401 407.
94. Ginsberg, J.S., I. Greer & J. Hirsh. 2001. Use of antithrombotic agents during pregnancy. Chest 119 (1 suppl. 122S 131S.
95. Wysowski, D.K., L. Talarico, J. Bacsanyi, et al. 1998. Spinal and epidural hematoma and low-molecular-weight heparin [4] (multiple letters). N. Engl. J. Med. 338 : 1774 1775.
96. Einhaupl, K.M., A. Villringer, W. Meister, et al. 1991. Heparin treatment in sinus venous thrombosis. Lancet 338 : 597 600.
97. Bousser, M. 2000. Cerebral venous thrombosis: diagnosis and management. J. Neurol. 247 : 252 258.
98. De Bruijn, S.F.T.M. & J. Stam. 1999. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke 30 : 484 488.
99. Einhäupl, K., M. Bousser, S.F.T.M. De Bruijn, et al. 2006. EFNS guideline on the treatment of cerebral venous and sinus thrombosis. Eur. J. Neurol. 13 : 553 559.
100. Stam, J. 2005. Current concepts: thrombosis of the cerebral veins and sinuses. N. Engl. J. Med. 352 : 1791 1798.
101. Aventis Pharmaceuticals. Lovenox Package Insert. 2002. Aventis Pharmaceuticals, Inc. Bridgewater, NJ.
102. Ahearn, G.S., D. Hadjiliadis, J.A. Govert & V.F. Tapson. 2002. Massive pulmonary embolism during pregnancy successfully treated with recombinant tissue plasminogen activator: a case report and review of treatment options. Arch. Intern. Med. 162 : 1221 1227.
103. Bechtel, J.J., M.C. Mountford & W.E. Ellinwood. 2005. Massive pulmonary embolism in pregnancy treated with catheter fragmentation and local thrombolysis. Obstet. Gynecol. 106 (5 II 1158 1160.
104. Dapprich, M. & W. Boessenecker. 2002. Fibrinolysis with alteplase in a pregnant woman with stroke [2]. Cerebrovasc. Dis. 13 : 290.
105. Johnson, D.M., D.C. Kramer, E. Cohen, et al. 2005. Thrombolytic therapy for acute stroke in late pregnancy with intra-arterial recombinant tissue plasminogen activator. Stroke 36 : e53 e55.
106. Nassar, A.H., M.E. Abdallah, G.V. Moukarbel, et al. 2003. Sequential use of thrombolytic agents for thrombosed mitral valve prosthesis during pregnancy. J. Perinat. Med. 31 : 257 260.
107. Patel, R.K., O. Fasan & R. Arya. 2003. Thrombolysis in pregnancy. Thromb. Haemost. 90 : 1216 1217.
108. Song, J.Y. & L. Valentino. 2005. A pregnant patient with renal vein thrombosis successfully treated with low-dose thrombolytic therapy: a case report. Am. J. Obstet. Gynecol. 192 : 2073 2075.
109. Trukhacheva, E., M. Scharff, M. Gardner & N. Lakkis. 2005. Massive pulmonary embolism in pregnancy treated with tissue plasminogen activator. Obstet. Gynecol. 106 (5 II 1156 1158.
110. Turrentine, M.A., G. Braems & M.M. Ramirez. 1995. Use of thrombolytics for the treatment of thromboembolic disease during pregnancy. Obstet. Gynecol. Surv. 50 : 534 541.
111. Usta, I.M., M. Abdallah, M. El-Hajj & A.H. Nassar. 2004. Massive subchorionic hematomas following thrombolytic therapy in pregnancy. Obstet. Gynecol. 103 (5 Pt 2 1079 1082.
112. Murugappan, A., W.M. Coplin, A.N. Al-Sadat, et al. 2006. Thrombolytic therapy of acute ischemic stroke during pregnancy. Neurology 66 : 768 770.
113. Elford, K., A. Leader, R. Wee & P.K. Stys. 2002. Stroke in ovarian hyperstimulation syndrome in early pregnancy treated with intra-arterial rt-PA. Neurology 59 : 1270 1272.
114. Méndez, J.C., J. Masjuán, N. García & M. De Leciñana. 2008. Successful intra-arterial thrombolysis for acute ischemic stroke in the immediate postpartum period: case report. Cardiovasc. Intervent. Radiol. 31 : 193 195.
115. Weatherby, S.J.M., N.C. Edwards, R. West & M.T.E. Heafield. 2003. Good outcome in early pregnancy following direct thrombolysis for cerebral venous sinus thrombosis [1]. J. Neurol. 250 : 1372 1373.
116. Aleu, A., P. Mellado, C. Lichy, et al. 2007. Hemorrhagic complications after off-label thrombolysis for ischemic stroke. Stroke 38 : 417 422.
117. Wiese, K.M., A. Talkad, M. Mathews & D. Wang. 2006. Intravenous recombinant tissue plasminogen activator in a pregnant woman with cardioembolic stroke. Stroke 37 : 2168 2169.
118. Horton, J.C., W.A. Chambers, S.L. Lyons, et al. 1990. Pregnancy and the risk of hemorrhage from cerebral arteriovenous malformations. Neurosurgery 27 : 867 872.
119. Sadasivan, B., G.M. Malik, C. Lee & J.I. Ausman. 1990. Vascular malformations and pregnancy. Surg. Neurol. 33 : 305 313.
120. Wiebers, D.O. 1988. Subarachnoid hemorrhage in pregnancy. Semin. Neurol. 8 : 226 229.
121. Robinson, J.L., C.J. Hall & C.B. Sedzimir. 1972. Subarachnoid hemorrhage in pregnancy. J. Neurosurg. 36 : 27 33.
122. Dias, M.S. & L.N. Sekhar. 1990. Intracranial hemorrhage from aneurysms and arteriovenous malformations during pregnancy and the puerperium. Neurosurgery 27 : 855 866.
123. Daane, T.A. & R.W. Tandy. 1960. Rupture of congenital intracranial aneurysm in pregnancy. Obstet. Gynecol. 15 : 305 314.
124. Pool, l. 1965. Treatment intracranial aneurysm during pregnancy. JAMA 192 : 209 214.
125. Schwartz, J. 1951. Pregnancy complicated by subarachnoid hemorrhage. Am. J. Obstet. Gynecol. 151 62 : 539 547.
126. Botterell, E.H. & D.E. Cannelli. 1956. Subarachnoid hemorrhage and pregnancy. Am. J. Obstet. Gynecol. 72 : 844 855.
127. Meyers, P.M., V.V. Halbach, A.M. Malek, et al. 2000. Endovascular treatment of cerebral artery aneurysms during pregnancy: report of three cases. Am. J. Neuroradiol. 21 : 1306 1311.
128. Piotin, M., C.B.A.D.S. Filho, R. Kothimbakam & J. Moret. 2001. Endovascular treatment of acutely ruptured intracranial aneurysms in pregnancy. Am. J. Obstet. Gynecol. 185 : 1261 1262.
129. Vougioukas, V.I., G. Kyroussis, S. Gläsker, et al. 2004. Neurosurgical interventions during pregnancy and the puerperium: clinical considerations and management. Acta Neurochir. (Wien) 146 : 1287 1292.