title: Thrombolysis with intravenous recombinant tissue plasminogen activator during early postpartum period: a review of the literature.
abstract: Thromboembolic events are one of the leading causes of maternal death during the postpartum period. Postpartum thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) is controversial because the treatment may lead to massive bleeding. Data centralization may be beneficial for analyzing the safety and effectiveness of systemic thrombolysis during the early postpartum period. We performed a computerized MEDLINE and EMBASE search. We collected data for 13 cases of systemic thrombolytic therapy during the early postpartum period, when limiting the early postpartum period to 48 hours after delivery. Blood transfusion was necessary in all cases except for one (12/13; 92%). In seven cases (7/13; 54%), a large amount of blood was required for transfusion. Subsequent laparotomy to control bleeding was required in five cases (5/13; 38%), including three cases of hysterectomy and two cases of hematoma removal, all of which involved cesarean delivery. In cases of transvaginal delivery, there was no report of laparotomy. The occurrence of severe bleeding was high in relation to cesarean section, compared with vaginal deliveries. Using rt-PA in relation to cesarean section might be worth avoiding. However, the paucity of data in the literature makes it difficult to assess the ultimate outcomes and safety of this treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Fukuoka Red Cross Hospital, Fukuoka, Japan.
authors.forename: Munetoshi
authors.identifier: http://orcid.org/0000-0003-3378-8546
authors.initials: M
authors.lastname: Akazawa
authors.affiliation: Department of Obstetrics and Gynecology, Fukuoka Red Cross Hospital, Fukuoka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nishida
mesh_terms: D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D049590:Postpartum Period; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D013923:Thromboembolism / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Cesarean section; postpartum; pulmonary embolism; thrombolytic therapy; tissue plasminogen activator