Intravenous Tenecteplase for Acute Ischemic Stroke During Active Menstruation

TL;DR

A woman received stroke treatment during her period and had no complications, suggesting it might be safe for menstruating women under certain conditions.

Contribution

This case report explores the use of IV tenecteplase in a menstruating female with acute ischemic stroke.

Findings

The patient received IV tenecteplase during active menstruation without adverse events.

Neurological deficits resolved completely at follow-up.

The case highlights the need to consider menstruation as a relative contraindication in stroke treatment decisions.

Abstract

We report a case of a 51-year-old female who presented to the emergency department with stroke symptoms within the time window for intravenous (IV) thrombolytic therapy. Her initial CT head imaging showed no evidence of acute changes and her CT perfusion demonstrated an area of ischemia in the left parieto-occipital region. While she had no absolute contraindications for IV tenecteplase (TNK), she was actively menstruating at the time, which could represent a relative contraindication due to increased bleeding risk from a site that would not be easily compressible. She elected to receive TNK and did not experience any adverse events after treatment was administered. At her follow-up clinic visit, her neurological deficits were completely resolved.

In the context of increasingly widespread usage of TNK, this case report highlights an uncommon but important consideration when treating acute ischemic strokes with IV thrombolytic in the female population. While no definitive conclusions should be drawn from this case, it would hopefully encourage the continued usage of TNK in menstruating females who present with stroke symptoms within the therapeutic window and with no other contraindications.

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