Maternal and Fetal Safety Outcomes of Thrombolytics for Ischemic Stroke in Pregnancy: A Systematic Review and Aggregated Case Series

The safety of intravenous thrombolytics for ischemic stroke in pregnancy is largely unknown. We performed a systematic review to identify published use of thrombolytics for stroke during pregnancy, with the aim of assessing maternal and fetal safety outcomes. To provide additional safety data, we included cases of thrombolysis for deep vein thrombosis, mechanical valve thrombosis, and pulmonary embolism in pregnancy.

We used the PRISMA and MOOSE guidelines to conduct the review. We searched 3 databases (OVID Medline, EMBASE, Scopus) for studies published up to October 2025. We analyzed outcomes in a Bayesian aggregated case series to compare rates of adverse outcomes in our cohort with those in the general population. Elective termination and spontaneous abortion were grouped together, given that it was often difficult to determine whether complications of thrombolysis may have played a role in the decision for termination.