Factors Associated with Thrombolysis Outcome in Ischemic Stroke Patients with Atrial Fibrillation

Abstract

The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation (AF) is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-related ischemic stroke remains largely unknown. In this study, we investigated factors that influence the effect of intravenous thrombolysis in these patients. Our results showed that thrombolysis was independently associated with a favorable outcome (P < 0.001) and did not influence the mortality of AF-related ischemic stroke, although it increased the risk of hemorrhage within 24 h after treatment. Risk factors for a poor outcome at admission were: heart failure (P = 0.045); high systolic pressure (P = 0.039); high blood glucose (P = 0.030); and a high National Institutes of Health Stroke Scale (NIHSS) score (P < 0.001). Moreover, high systolic pressure at admission (P = 0.007), high blood glucose (P = 0.027), and a high NIHSS score (P < 0.001) were independent risk factors for mortality at 3 months. Besides thrombolysis, a high NIHSS score (P = 0.006) and warfarin taken within 48 h before stroke onset (P = 0.032) were also independent risk factors for symptomatic hemorrhage within 24 h after treatment. Ischemic stroke patients with AF benefited from intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after stroke.

Predictors of Postthrombolysis Outcome and Symptomatic Postthrombolysis Hemorrhage following Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke

“…Thrombolysis independently predisposed to a favorable outcome but did not significantly reduce mortality. 13 Huang et al described that patients with no history of diabetes, leukoaraiosis, low blood glucose level, low systolic BP level, and low baseline NIHSS score before thrombolysis had better outcome. 14 Thus, the findings of the majority of the studies performed worldwide were in unison with our results.…”

“…We analyzed the following variables: age, gender, domestic arrangements (living alone or with family members), ongoing medications, histories of vascular risk factors including hypertension, diabetes mellitus, heart diseases (ischemic heart disease, low ejection fraction [EF], and atrial fibrillation [AF], either as a history of AF or AF diagnosed during the index admission by electrocardiography), TIA, current or former smoking, and hypercholesterolemia. At admission, the stroke severity was ascertained by a neurologist experienced in NIHSS evaluation and was classified as mild (0-4), moderate (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), or severe . According to the Bamford criteria, 8 strokes were classified in total anterior circulation stroke (TACS), partial anterior circulation stroke, posterior circulation stroke, and lacunar stroke.…”

Efficacy and safety of thrombolysis for acute ischemic stroke with atrial fibrillation: a meta-analysis

“…Baseline characteristics of patients included in these studies were shown in Table 1 and Table 2. Eleven studies [6,8,10,[12][13][14][16][17][18][19]24] compared IVT-treated AF to non-AF patients, two studies [20][21] compared IVT-treated to non-IVT in AF patients, and five studies [5,7,9,11,15] included two kinds of comparative data mentioned above. Figure 2A).…”

“…Most studies showed that higher mortality [5][6][7][8][9][10][11][12][15][16][17][18][19] and sICH incidence [5, 7-12, 16-17, 19] in AF patients pretreated IVT than which of non-AF. Compare AF patients with and without IVT, some studies revealed IVT had a high proportion of excellent functional outcomes than non-IVT therapy [7,9,15,[20][21], however several other studies have done the opposite conclusion [5,11]. In AF patients with IVT therapy, five studies showed lower mortality [7,9,15,[20][21] than non-IVT therapy.…”

“…Compare AF patients with and without IVT, some studies revealed IVT had a high proportion of excellent functional outcomes than non-IVT therapy [7,9,15,[20][21], however several other studies have done the opposite conclusion [5,11]. In AF patients with IVT therapy, five studies showed lower mortality [7,9,15,[20][21] than non-IVT therapy. On the contrary, two studies displayed higher [5,11].…”