Table 1: Selected outcomes for each PICO and respective average voting for importance of

the members

PICO 1 PICO 2

Outcomes Average Outcomes Average

Stroke, all 9 mRS at 90 days 9

Stroke, ischaemic 9 recanalization (MT) 7

Stroke, haemorrhagic 9 Treatment 7

complications (MT)

CVT 8 Early neurological 6

improvement

Transient Ischaemic 8 Mortality, all cause, 9

attack overall

Myocardial infarction 6 Intra-hospital mortality 9

(MI)

Cardiovascular and MI 7 Quality of life 5

events

Angina 6 Haemorrhage 9

Coronary disease 6 Major bleeding 9

Sytemic embolism 7 Minor bleeding 6

Mortality, all cause 9 Intracerebral 9

haemorrhage

Mortality, cardiac 6 Symptomatic cerebral 9

haemorrhage

IMT 5 Intracranial bleeding 9

Functional outcome mRS 8 Gastrointestinal 5

3 months bleeding, major/minor

Depression 6 Gastrointestinal 9
bleeding, major

Cognition/Dementia 6 Gastrointestinal 6
bleeding, minor

Fatigue 6 Complication in 9
pregnancy

Breast Cancer 6 Premature delivery 8

 Quality of life, ADL 5 Abortion 9

Osteoporosis 5 Healthy baby 8

Fractures 6 Bleeding vaginal, 6

major/minor

Major bleeding 7 Bleeding vaginal, 6

major

Minor bleeding 6 Bleeding vaginal, 5

minor

Bleeding vaginal, major 6 Bleeding placenta 6

Bleeding vaginal, minor 5

Menopausal hot flushes 6

CVT: cerebral venous thrombosis, IMT: Intima Media Thickness

Rating of outcomes points according to importance: 9-7 critical, 4-6 important, 0-3 less important

Table 2: Summary of case reports of intravenous thrombolysis alone or in combination with

mechanical thrombectomy in pregnant women with acute ischaemic stroke

Authors Age; Treatment Stroke description NIHSS Haemorrhag Clinical Fetal

Gestation (route; score e Outcome outcome
dose)
Dapprich et 31 years; IV rt-PA; Right - sided hemiplegia and NR Small Improved. Healthy
al, 2002 12 weeks 0.9mg/kg global aphasia. Left basal L-MCA baby
L-MCA occlusion; protein S ganglia reopened.
deficiency. haemorrhagic
infarction
Leonhardt et 26 years; IV rt-PA; R-sided hemiparesis. NR No Good Healthy
al, 2006 23 weeks 0.9mg/kg L-MCA occlusion. improvement. baby
anti-phospholipid L-MCA partial
antibodies; protein S reocclusion.
deficiency.
Murugappan 37 years; IV rt-PA; Left-sided weakness and 19 Intraut. Recovered well. MTP
et al, 2006 12 weeks 0.9mg/kg numbness, lower facial haematoma
droop, dysarthric speech.
R-MCA occlusion; mitral
valve replacement
embolism.
Murugappan 31 years; IV rt-PA; Right-sided hemiparesis and 19 No Improvement in MTP
et al, 2006 12 weeks 0.9mg/kg severe expressive aphasia. right-sided
L-MCA occlusion; protein S motor function
deficiency. and speech.
NIHSS score - 4
after 4 weeks.
Wiese et al, 33 years; IV rt-PA; Right-sided hemiparesis and 13 No Good Healthy
2006 13 weeks 0.9mg/kg expressive aphasia. improvement. baby
L-MCA occlusion. NIHSS score - CS
Authors Age; Treatment Stroke description NIHSS Haemorrhag Clinical Fetal
Gestation (route; score e Outcome outcome
dose)
mitral valve replacement. 11, then 4.
Yamaguchi 36 years; IV rt-PA; Right-sided hemiparesis, 6 No Recovered Healthy
et al, 2010 18 weeks 0.6mg/kg motor aphasia. Well. baby
L-MCA occlusion; Factor
VIII elevation (>200%);
protein C resistance.
Ratajczak et 33 years; 6 IV rt-PA; Right-sided hemiparesis and NR No Neurological Healthy
al, 2012 weeks Standard expressive aphasia. symptoms baby
dose Restricted diffusion in three improved
different areas in the left rapidly.
hemisphere; PFO and right-
left shunt.
Hori et al, 35 years; IV rt-PA; Left -sided visual field NR No Improved Healthy
2013 14 weeks 0.6mg/kg defect, hemiparesis, and baby
dysesthesia. CS
R-PCA occlusion.
35% patients - protein S
deficiency.
Karunaratne 30 years; IV tPA; Left-sided weakness. 12 NR Symptoms Healthy
et al, 2013 38 weeks Dose NR improved baby
rapidly.
NIHSS score - 1
after 2 days
Tassi et al, 28 years; IV rt-PA; Right-sided hemiparesis and 20 No Motor aphasia, Healthy
2013 16 weeks 0.9mg/kg hypoesthesia, motor aphasia, hemiparesis baby
L-MCA subocclusion; improved within
paradoxical embolism due to a few hours.
PFO and Factor V Leiden NIHSS score-1
mutation. after 1 day.
Mantoan 32 years; IV rt-PA; Left middle cerebral artery 22 No NIHSS score – Healthy
Ritter L et al, 16 weeks 0.9mg/kg syndrome - dysphasia, 13 baby
2014 dysarthria, right-sided 4 month later – CS
hemianopia, hemiplegia, mild residual
and hemisensory loss. hemiparesis,
fully
L-MCA M2 segment independent
occlusion mRS-2
Ritchie et al, 28 years; IV rt-PA; Left-sided hemiparesis, 11 No Fully recovered. Healthy
2015 39 weeks NR facial weakness and tongue NIHSS score - 6 baby,
deviation, impaired after 1 day forceps
sensation. assisted
R-MCA occlusion. vaginal
Cryptogenic stroke. delivery

Tversky et al, 31 years; IV t-PA; Right-sided mild 5 No Full recovery Healthy

2016 5 weeks NR hemiparesis, slurred speech, baby
hemisensory loss.
L-MCA occlusion;
paradoxical embolism due to
PFO; protein C and S
deficiency.
Reining- 37 years; IV rt-PA; Left-sided hemiplegia. 8 No Recovered well. Healthy
Festa et al, 5 weeks Standard Restricted diffusion of R- NIHSS score-4, baby,
2017 dose MCA. mRS after 3 CS
months – 1.
Kalcik M et 28 years; t-PA 25 Thrombus on the mitral NA No Hemiplegia Healthy
Authors Age; Treatment Stroke description NIHSS Haemorrhag Clinical Fetal
Gestation (route; score e Outcome outcome
dose)
al, 2017 24 weeks mg/2h prosthesis resolved baby was
Right hemiplegia delivered
Thrombotic occlusion of left
MCA
Khan A et 33 years; NR Right-sided hemiparesis, NA No Mild fine motor At day three
al., 2017 9 weeks hemisensory loss, incoordination in postthrombo
dysarthria and homonymous the right hand, lysis the
hemianopia mild dysarthria, patient
(History - eleven and right requested a
miscarriages of, cocaine, homonymous termination
heroin, cannabis abuse) hemianopia of
pregnancy
Landais et al, 32 years; IV rt-PA; Right hand numbness and No Recovered Healthy
2018 13 week 0.9mg/kg aphasia. Well. baby
M2 segment L-MCA
occlusion.
Jiang Z and 26 years; IV rt-PA; Right sided hemiparesis, 6 Asympt. NIHSS score 3, Healthy
Hu Z, 2018 31 week Standard slurred speech haemorrhage after baby,
dose in left haemorrhage 4 Vaginal
cerebellar (mitral valve delivery
hemisphere prolapse)
and right
cortex
Shah SS et 37 years; IV rt-PA; Acute left-sided hemiplegia 9 NIHSS score 4,
al, 2018 9 weeks 0.9mg/kg and right gaze preference Left-sided
M2 segment R-MCA hemiplegia and
occlusion. right gaze
preference
MT 2 days later – again left- 13 resolved
sided hemiplegia and right EVT –
gaze preference recanalization
TICI 2b
NIHSS - 3
Ryman KM 26-years IV rt-PA; Expressive aphasia and right 29 No Without residual Unspecified
et al, 2019 12 weeks 0.9mg/kg hemiparesis, after 90 min deficits complicatio
resolution of symptoms ns of
30 min later less severe 4 prematurity.
symptoms No birth
defects
Delivery
without
complicatio
ns
Ryman KM 24 years, IV – rtPA – Right hemiparesis, right 12 No Marked Healthy
et al, 2019 30 weeks dose NR upper extremity sensory neurologic baby at
loss, and dysarthria improvement Without
complicatio
ns
Peksa GD et 35 years, IV – rtPA Lost balance and unable to 7 No NIHSS 0, mRS Healthy
al, 2019 9 weeks 0.9 mg/kg move the left side of body 1 baby
Right M1-MCA filling (hyperbiliru
defect (CT AG) binemia)
vaginal
delivery
Rodrigues R 29 years IV – rtPA Aphasia, right-sided 23 No Motor aphasia Healthy
et al, 2019 27 weeks hemiplegia, hemianopsia and right baby
Authors Age; Treatment Stroke description NIHSS Haemorrhag Clinical Fetal
Gestation (route; score e Outcome outcome
dose)
Occlusion of the proximal hemiparesis Cesarean
left MCA persisted, gait delivery
with bilateral
support, NIHSS
14.
Aaron S et al, 35 years; IV – rtPA Right-sided weakness and 11 No Improvement in Healthy
2020 39 weeks 0.9 mg/kg inability to speak right baby,
hemiparesis Vaginal
improved fully delivery
and language

At 3 months,
word finding
difficulty for low
frequency words
Bojda M et 31 years, IV – rtPA Slurred speech, severe right 16 No NIHSS 4 after Healthy
al, 2021 34 weeks 0.9 mg/kg hemiparesis, facial 7h, 1 after 10 male infant
palsy, psychomotor agitation days Vaginal
delivery
Bhogal P et 36 years, 36 mg Headache, blurred vision, NR No mRS - 1 CS, healthy
al, 2017 25 weeks IV rt-Pa, and nausea, several episodes baby
combined of vomiting, than rapid
with deterioration of
MT with consciousness and patient
aspiration became stuporous.
catheter and Distal occlusion of the
later MT basilar artery.
with stent
retriever
Zhu F et al, 28 years, 0.9mg/kg Right motor and sensitive 13 No NIHSS score - 1 Healthy
2018 9 weeks IV rt-PA deficit with dysarthria baby,
combined experienced on waking. vaginal
with M1 segment L- MCA delivery
MT with occlusion.
aspiration
Watanabe TT 36 years IV rtPA Dysarthria and right 13 No NIHSS score – Healthy
et al., 21 weeks 0.6mg/kg hemiparesis 4, baby,
2019 Penumbra, Left ICA occlusion mRS 1 after Delivery
Trevo XP delivery without
complicatio
ns
Kristiansen E 26 years IV rtPA 90 Left-sided paralysis, facial 14 No 2 weeks after Healthy
et al., 33 weeks mg weakness, inattention, disacharge - baby
2019 MT - Trevo dysarthria, and incomplete slight facial
stent left vertical gaze palsy palsy, reduced
retriever Right M1- MCA occlusion fine motor skills
of the left arm,
and slight
cognitive
deficits
Tse GH et al., 36 years, IV tPA Dysphasia and right 21 No Excellent Healthy baby
2019 8 weeks Stent- hemiplegia recovery from
retriever Thrombus in the proximal hemiplegia, but Uneventful
mechanical left MCA dysphasia was delivery
thrombecto slow to improve
my
Limaye K et NA IV tPA Right M1-MCA occlusion 15 No Discharge Normal full-
Authors Age; Treatment Stroke description NIHSS Haemorrhag Clinical Fetal
Gestation (route; score e Outcome outcome
dose)
al., Second SMAT NIHSS – 3 term
2020 trimester 90 days mRS - 1 delivery
Limaye K et NA IV tPA Right M1-MCA occlusion 11 HI-1 Discharge Spontaneous
al., First ADAPT NIHSS – 1 abortion
2020 trimester 90 days mRS - 1
Limaye K et NA IV tPA Right M1-MCA occlusion 12 No Discharge Normal full-
al., Third SMAT NIHSS – 1 term
2020 trimester using BGC 90 days mRS - 1 delivery

ADAPT – a direct aspiration first pass technique; BGC – balloon guide catheter; CT AG - Computed
tomography angiography, CS – Cesarean section; HI-1 – haemorrhagic infarction type 1; ICA – internal carotid
artery; IV: Intravenous; IVT – intravenous thrombolysis, L-MCA: Left middle cerebral artery; mRS: modified
Rankin Scale score; MAT – mechanical aspiration thrombectomy; MT – mechanical thrombectomy; MTP:
Medical termination of pregnancy; NIHSS: National Institutes of Health Stroke Scale; NR: Not reported; ; NA –
Not available; PFO: Patent foramen ovale; R-MCA: Right middle cerebral artery; rt-PA: Recombinant tissue
plasminogen activator; R-PCA: Right posterior cerebral artery; SMAT – stent assisted mechanical aspiration
thrombectomy; tPA: Tissue plasminogen activator; TE – thrombectomy;
 Table 3: Summary of case reports of mechanical thrombectomy and intraarterial thrombolysis
in pregnant women with acute ischaemic stroke

Authors Age/gestation Treatment Stroke description NIHSS Haemorrhage Outcome Fetal outcome
route; dose score
Elford et al, 28 years, IA 15.5 mg Left hemiplegia, 11 Small 1.5- 2.0 NIHSS score 3, Healthy male
2002 7 days after rtPA dysarthria, cm hematoma Deterioration, at infant, vaginal
transfer of left facial paralysis, and in the right follow-up, mRS delivery
embryo drowsiness. basal ganglia, 1-2
M1 segment R-MCA later to 3 cm
occlusion.
Denschlag et 28 years, IA Eye deviation, NR No Good outcome. Pregnancy
al, 2005 25 weeks 30mg rtPA horizontal Complete terminated by
nystagmus, paralysis of resolution of the combined CS
the upper extremities mitral thrombus and HE
and dysarthria. under warfarin because of
BA thrombosis therapy. mitral valve
thrombus

Thriving infant
Johnson DM 39 years, IA Left-sided hemiplegia, 20 No NIHSS score 7 Healthy baby,
et al, 37 weeks 15 mg rtPA decreased after 9 hours forceps
2005 responsiveness. assisted
M1 segment R-MCA vaginal
occlusion. delivery
Yamada N et 34 years, IA urokinase Left side semiparalysis 8 No Recovered well NR
al, 2010 39 week and articulation
disorder.
Aaron S 24 years, MT with Left-sided hemiplegia, 20 No NIHSS score Healthy baby,
et al, 2016 3rd trimester Penumbra hemineglect and altered 12, vaginal
system sensorium. mRS – 1 at delivery
M1 segment R-MCA discharge, after
occlusion. 6 months - 0
Aaron S 28 years, MT with Left hemiplegia and 21 No NIHSS score 4, Healthy baby
et al, 2016 37 weeks Penumbra Drowsiness. mRS after 6 girl, vaginal
system M1 segment R-MCA months - 2 delivery
occlusion.
Bhogal P et 38 years, Solitaire AB Right-sided hemiplegia 15 No mRS - 1 Healthy baby,
al, 2017 24 weeks Stent, manual and hemianaesthesia, vaginal
aspiration, aphasia, deviated gaze delivery
IA 9 mg rtPA to the left.
Terminal internal
carotid artery (ICA)
occlusion.

Blythe R et 29 years, Clot Left facial paresis, 11 No mRS 0 after 6 Caesarean

al, 2019 39 weeks aspiration hemiparesis, and neglect weeks section 5 days
Large occlusive after MT,
thrombus within the delivering a
right M1- M2 segments healthy new
born
Tse GH et 28 years, Thrombus Right hemiplegia, facial 11 No Minimal Elective
al., 39 weeks aspiration droop and dysarthria residual facial caesarean
2019 with Left M1-MCA weakness section at 40
Penumbra occlusion weeks with
safe delivery of
 system child

Tse GH et 27 years, MT - stent Right-sided hemiplegia 22 No No significant Normal

al., 36 weeks retriever Proximal left MCA neurological delivery
2019 thrombus, complete deficit
occlusion, good
collaterals
Limaye K et NA SMAT using Left M1-MCA 18 No Discharge NA
al., Second BGC occlusion NIHSS – 5
2020 trimester 90 days mRS -
2
Limaye K et NA 3xMAT, Right ICA terminus 12 No Discharge Normal full-
al., Third trimester 2xstent occlusion NIHSS – 0 term delivery
2020 retriever, 90 days mRS -
rescue 0
stenting
Limaye K et NA MAT Right M1-MCA 28 No Discharge Normal full-
al., Third trimester occlusion NIHSS – 0 term delivery
2020 90 days mRS -
0
Limaye K et NA SMAT Left M1-MCA 9 No Discharge NA
al., First trimester occlusion NIHSS – 2
2020 30 days mRS -
0
Wiacek M et 27 years, Mechanical dysarthria, motor 15 No 24 hours Healthy baby,
al., 35 week thrombectomy aphasia, partial right- NIHSS – 7 Cesarean
2020 sided hemianopia and Discharge section before
hemiparesis NIHSS – 1 MT
Cesarean section, then After 3 months
DSA - left MCA NIHSS – 0,
occlusion mRS - 0

Bhogal P et 36 years, 36 mg Headache, blurred NR No mRS - 1 CS, healthy

al, 2017 25 weeks IV rt-Pa, vision, and nausea, baby
combined several episodes of
with vomiting, than rapid
MT with deterioration of
aspiration consciousness and
catheter and patient became
later MT with stuporous.
stent retriever Distal occlusion of the
basilar artery.
Zhu F et al, 28 years, 0.9mg/kg Right motor and 13 No NIHSS score - Healthy baby,
2018 9 weeks IV rt-PA sensitive deficit with 1 vaginal
combined dysarthria experienced delivery
with on waking.
MT with M1 segment L- MCA
aspiration occlusion.
Watanabe 36 years IV rtPA Dysarthria and right 13 No NIHSS score – Healthy baby,
TT et al., 21 weeks 0.6mg/kg hemiparesis 4, Delivery
2019 Penumbra, Left ICA occlusion mRS 1 after without
Trevo XP delivery complications
Kristiansen 26 years IV rtPA 90 Left-sided paralysis, 14 No 2 weeks after Healthy baby
E et al., 33 weeks mg facial weakness, disacharge -
2019 MT - Trevo inattention, dysarthria, slight facial
stent retriever and incomplete left palsy, reduced
vertical gaze palsy fine motor skills
Right M1- MCA of the left arm,
occlusion and slight
cognitive
 deficits
Tse GH et 36 years, IV tPA Dysphasia and right 21 No Excellent Healthy baby
al., 8 weeks Stent-retriever hemiplegia recovery from
2019 mechanical Thrombus in the hemiplegia, but Uneventful
thrombectomy proximal left MCA dysphasia was delivery
slow to improve
Limaye K et NA IV tPA Right M1-MCA 15 No Discharge Normal full-
al., Second SMAT occlusion NIHSS – 3 term delivery
2020 trimester 90 days mRS -
1
Limaye K et NA IV tPA Right M1-MCA 11 HI-1 Discharge Spontaneous
al., First trimester ADAPT occlusion NIHSS – 1 abortion
2020 90 days mRS -
1
Limaye K et NA IV tPA Right M1-MCA 12 No Discharge Normal full-
al., Third trimester SMAT using occlusion NIHSS – 1 term delivery
2020 BGC 90 days mRS -
1

ADAPT – a direct aspiration first pass technique; BGC – balloon guide catheter; CS-Cesarean section; HE-
Hysterectomy; HI-1 – haemorrhagic infarction type 1; IA: Intraarterial; IV: Intravenous; L-MCA: Left middle
cerebral artery; mRS: modified Rankin Scale score; MAT – mechanical aspiration thrombectomy; NA – Not
available; NIHSS: National Institutes of Health Stroke Scale; NR: Not reported; R-MCA: Right middle cerebral
artery; rt-PA: Recombinant tissue plasminogen activator; MT – mechanical thrombectomy, ICA – internal
carotid artery, SMAT – stent assisted mechanical aspiration thrombectomy, BGC – balloon guide catheter,
 Table 4: Summary of case reports intravenous thrombolysis and mechanical thrombectomy
in postpartum women with acute ischaemic stroke

Authors Age/ Treatment Stroke description NIHSS Haemorrhage Clinical

postpartum (route; dose) score Outcome
time
Bereczki et 40 years; IV rt-PA; Right-sided hemiparesis, 23 No mRS – 1,
al, 2016 10 days 0.9mg/kg central facial palsy, after 6 weeks
dissection of R- aphasia, conjugated gaze mRS - 0
ICA - fixed by deviation to the
carotid left, anisocoria
Wallstent M1 segment L-MCA
occlusion,
R-ICA 65-70% stenosis,
L-ICA occlusion
Nasa P et 39 years IV rt-PA; dose Left-sided numbness and 8 No NR
al., 2 months – NR weakness, facial
after delivery Enoxaparin, asymmetry, and difficulty
2021 warfarin in speech
(peripartum
cardiomyopathy
(PPCM)

ICA – internal carotid artery; IV: Intravenous; IVT – intravenous thrombolysis, L-MCA: Left middle cerebral
artery; L-ICA: Left internal carotid artery; mRS: modified Rankin Scale score; R-ICA: Right internal carotid
artery; rt-PA: Recombinant tissue plasminogen activator;
 Table 5: Summary of case reports of intraarterial thrombolysis during the postpartum period

Authors Age/ Treatment Stroke description NIHSS Haemorrhag Outcome

postpartum route; dose score e
time
Cincotta et 22 years, 1,000,000 U of Drowsy, but able to NR No Recovery after 2
al, 1995 14 days after urokinase follow commands. months,
delivery injected in Bilateral horizontal complete after 1
increments of gaze palsies. Absent year
200,000 U gag reflex, incomplete
quadriparesis. Patient
was on ventilation.
Basilar artery
thrombosis.
DeKoninck 33 years, IA Dizziness, nausea, NR No Death
PLJ et al, 19 days after thrombolysis, vomitus, than apnea
2008 delivery dose NR and cardiac arrest.
Basilar and internal
carotid occlusion.
Mendez JC 37 years, IA urokinase Sudden onset of left 16 No NIHSS score -2,
et al, 2008 15 hours after 100,000 units face, arm, and leg after 3 months
Cesarean over a period of hemiplegia, without deficit
delivery 15 min. homonymous
hemianopsia, and
slight dysarthria.
Tomita T et 29 years, IA 20 mg rt-PA Right-sided 14 No Recovery,
al, 2010 3 days after hemiplegia, global NIHSS score - 1
delivery aphasia. after 4 months
M2 segment L-MCA
occlusion.
Ronning 29 years Intra-arterial rt- Tachycardia and 14 No Mild right facial
OM et al., 3 days after PA – 20 mg dyspnoea with paralysis,
2010 delivery orthopnoea, a left reduced tempo
ventricular thrombus of the right
was detected, then hand, a partial
right-sided non-fluent
hemiplegia with global aphasia
aphasia. After 4 months –
Left M2-MCA NIHSS 1, mRS
occlusion 1

IA: Intraarterial; L-MCA: Left middle cerebral artery; mRS: modified Rankin Scale score; NIHSS: National
Institutes of Health Stroke Scale; NR: Not reported; rt-PA: Recombinant tissue plasminogen activator
 Table 6: Summary of case reports of intravenous thrombolysis in women with acute
ischaemic stroke during menstruation

Authors Menstruation Treatment Stroke NIHSS Haemorrhage Clinical

(route; dose) description score Outcome
Wein TH 40 years; IV rt-PA; Right-sided 10 After 25 min. of IV rt- NIHSS score – 5
et al, 2002 20 hours of her 0.9mg/kg per hemiparesis, PA - marked increase in after 3-weeks.
menses. NINDS dysphasia, menstrual flow.
protocol dysarthria. IV fluids without
M1 segment response.
L-MCA Transfusion of 2 U of
occlusion packed red
blood cells.

Chandran, 36 years; IV rt-PA; Left-sided 12 No increase in her NIHSS score – 4

2015 0.9mg/kg per hemiplegia, menstrual bleeding or at discharge after
NINDS dysarthria. drop in hemoglobin. 3-days.
protocol Occlusion
M1 segment
R-MCA.

IV: Intravenous; IVT – intravenous thrombolysis, L-MCA: Left middle cerebral artery; mRS: modified Rankin
Scale score; NIHSS: National Institutes of Health Stroke Scale; R-MCA: Right middle cerebral artery; rt-PA:
Recombinant tissue plasminogen activator; rt-PA: recombinant tissue plasminogen activator
Table 7: Synoptic table of the recommendations including all member votes of the expert
consensus voting

PICO Recommendation Expert consensus

statement
1. Hormone replacement therapy (HRT) and stroke risk In menopausal women
1.1. In menopausal women, does HRT compared to non-prior we suggest against the
HRT reduce the risk of ischaemic stroke? use of HRT to reduce
the risk of ischaemic
stroke.
Quality of evidence:
Very low ⊕
Strength of
recommendation: Weak
against intervention ↓
1.2 In menopausal women, does HRT compared to non-prior In menopausal women
HRT reduce the risk of haemorrhagic stroke in primary we suggest against the
prevention? use of HRT to reduce
the risk of haemorrhagic
stroke.
Quality of evidence:
Low ⨁⨁
Strength of
recommendation: Weak
against intervention ↓
1.3 In menopausal women with acute ischaemic stroke, does In menopausal women
prior HRT compared with non- prior HRT impact functional with acute ischaemic
outcome and mortality? stroke we suggest
against the use of HRT
to reduce mortality.
Quality of evidence:
Very low ⨁
Strength of
recommendation: Weak
against intervention ↓
2. Treatment of acute ischaemic stroke in pre-menopausal Since only data from A majority of
women (pregnancy, postpartum, and menstruation) case reports are members (12/13)
2.1 In pregnant women with acute ischaemic stroke does available, a specific suggests that
intravenous thrombolysis (IVT) improve outcome as compared recommendation on pregnant women
to no IVT? IVT in pregnant women with acute
cannot be made. disabling
ischaemic stroke,
can be treated with
IVT.
2.2 In women with acute ischaemic stroke during the Since only data from All members
postpartum period does IVT improve outcome as compared to case reports are (13/13) suggest
no IVT? available, a specific that postpartum
recommendation on women, occurring
IVT in postpartum at least 10 days
women cannot be made. after delivery, can
be treated with
IVT.
2.3 In women with acute ischaemic stroke during menstruation Since only data from All members
does IVT improve outcome as compared to no IVT? case reports are (13/13)suggest
available, a specific that women with
recommendation on acute ischaemic
IVT in women during stroke during
 menstruation cannot be menstruation, can
made. be treated with
IVT.
Since only data from All members
2.4 In women with acute ischaemic stroke during pregnancy case reports are (13/13) suggest
does mechanical thrombectomy (MT) or intraarterial available, a specific that pregnant
thrombolysis (IAT) improve outcome as compared to no recommendation on MT women with
mechanical thrombectomy and/or IVT? or IAT in pregnant stroke and large
women cannot be made. vessel occlusion
can be treated with
MT.
A majority (12/13)
of members
suggests that in
pregnant women
MT alone should
be preferred over
IVT or bridging
therapy
(IVT+ET).
2.5. In women with acute ischaemic stroke during postpartum No data, case reports It is reasonably
period does endovascular treatment improve outcome as available plausible that
compared to no endovascular treatment and/or IVT? postpartum
women with
stroke might
benefit from MT .
Furthermore, a
majority of
members (12/13)
suggests that is
reasonably
plausible to prefer
MT alone over
IVT or bridging
therapy (IVT+ET)