Tenecteplase Use in Pregnancy: Case Report and Literature Review

Abstract

Background:

Stroke is a serious complication of pregnancy and affects approximately 30 per 100,000 pregnancies. Pregnancy-related hypercoagulability and hemodynamic changes increase the risk. Tenecteplase (TNK) has emerged as an alternative to alteplase for acute ischemic stroke (AIS) due to ease of administration. However, limited evidence exists regarding its use during pregnancy.

Case:

A 32-year-old woman at 24 weeks gestation presented with sudden-onset left facial droop, weakness, numbness, and dysarthria (NIHSS 9). Imaging revealed an acute right middle cerebral artery infarct without hemorrhage or large vessel occlusion. Following multidisciplinary consultation, intravenous TNK was administered within 4.5 hours of symptom onset. The patient’s symptoms improved rapidly, and she was discharged with an NIHSS of 2. At 37 weeks, she delivered a healthy male infant via spontaneous vaginal delivery without complications.

Conclusion:

This is the first reported U.S. case of intravenous TNK administration for AIS during the second trimester of pregnancy, resulting in full maternal and fetal recovery. TNK may offer a safe and effective thrombolytic option for selected pregnant patients when guided by multidisciplinary evaluation and timely intervention.