Public Release: 

Clot-busting stroke therapy appears safe for menstruating women

American Heart Association

DALLAS, Oct. 4 - In emergency stroke treatment, the clot buster tissue plasminogen activator (tPA) can be safely given to women who are menstruating. However, it must be used with caution in those with a history of dysfunctional uterine bleeding, according to the first report of its kind published in the October issue of Stroke: Journal of the American Heart Association.

The drug is the only Food and Drug Administration-approved treatment for acute stroke. Research indicates that tPA can reduce permanent disability if given within three hours of the onset of stroke symptoms.

Currently, women who are menstruating at the time of stroke may not receive tPA because the drug could cause excessive bleeding, says lead author Theodore H. Wein, M.D., assistant professor of neurology and neurosurgery at McGill University in Montreal, Canada.

Wein reports that he gave tPA to a 40-year-old menstruating woman having a stroke. The woman had lost part of her language abilities and was paralyzed on her right side.

"We explained the risks of tPA, as well as the possibility that if bleeding did occur the worst-case scenario would be that she may need an emergency hysterectomy," says Wein. "She did have increased menstrual flow and required a blood transfusion but, otherwise, did very well and was left only with a minor deficit."

For this report, Wein and fellow researchers reviewed the National Institute of Neurological Disorders and Stroke (NINDS) database and found that five women given tPA treatment had been menstruating and only two had adverse events. One woman treated with tPA, who had a one-year history of continuous vaginal bleeding, required emergency surgery.

In a review of all medical literature to date, researchers found 25 women who received clot-busting medications while having their periods. These women were being treated for heart attack or deep vein thrombosis but not stroke. Of the 25, only two required transfusions and no serious health consequences occurred. "The message to doctors is based on a limited number of patients but indicates that tPA seems to be relatively safe to administer to women who are menstruating," Wein says. "Given that tPA must be given in the first three hours of stroke, we do not think that menstruation should delay treatment. "Women with a history of abnormal vaginal bleeding, however, should be treated with caution, as the patient may require emergency surgery."

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Co-authors on the study are: Susan L. Hickenbottom, M.D.; Lewis B. Morgenstern, M.D.; Andrew M. Demchuk, M.D.; and James C. Grotta, M.D.

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