Document Detail


First trimester stroke prophylaxis in pregnant women with a history of stroke.
MedLine Citation:
PMID:  19211492     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: Current recommendations for stroke prevention during early pregnancy in women with a prior stroke history are based on limited evidence. In view of the uncertainty involved in balancing the fetal risk of medication against the maternal risk of recurrent stroke, a substantial variation in clinical decision making was anticipated. Thus, a survey was performed to describe the current practices of U.S. neurologists with a particular interest in stroke with regards to treatment of such patients.
METHODS: A survey was sent to 384 actively practicing U.S. members of the American Academy of Neurology Stroke and Vascular Neurology section asking what antithrombotic, if any, they would use during first trimester pregnancy in women with a prior history of stroke, either unrelated or related to a previous pregnancy.
RESULTS: 230 practitioners responded. Some form of antithrombotic therapy was selected by 75% of practitioners for women with a history of prior stroke not related to pregnancy and by 88% of practitioners for women with a history of prior stroke related to pregnancy. Aspirin and low molecular weight heparin were chosen by 51% and 7%, respectively, for stroke unrelated to pregnancy and by 41% and 25%, respectively, for stroke related to pregnancy.
CONCLUSIONS: Most practitioners agree that women with a history of stroke should receive prophylaxis during the first trimester. However, much disagreement exists regarding which drug(s) to use. A national registry would be the most practical method of obtaining maternal and fetal outcome data to guide practice in this setting.
Authors:
Ann K Helms; Oksana Drogan; Steven J Kittner
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-02-10
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  40     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-03-31     Completed Date:  2009-04-24     Revised Date:  2014-09-20    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1158-61     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Anticoagulants / therapeutic use
Aspirin / therapeutic use
Female
Fibrinolytic Agents / therapeutic use*
Health Care Surveys
Heparin, Low-Molecular-Weight / therapeutic use
Humans
Medical History Taking
Platelet Aggregation Inhibitors / therapeutic use
Pregnancy
Pregnancy Complications, Cardiovascular / epidemiology*,  prevention & control*
Pregnancy Trimester, First
Questionnaires
Risk Factors
Stroke / epidemiology*,  prevention & control*
Grant Support
ID/Acronym/Agency:
R01 NS045012/NS/NINDS NIH HHS; R01 NS045012-05/NS/NINDS NIH HHS; R01 NS45012/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents; 0/Heparin, Low-Molecular-Weight; 0/Platelet Aggregation Inhibitors; R16CO5Y76E/Aspirin
Comments/Corrections

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