Multimode Computed-Tomography-Guided Thrombolysis under a Prolonged Time Window in Acute Ischemic Stroke Patients with Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is an independent risk factor for intracranial hemorrhage in patients receiving recombinant-tissue-type plasminogen activator (rt-PA) thrombolytic therapy. Research showed that patients with acute ischemic stroke (AIS) could benefit from multimode computed-tomography-(CT-) guided intravenous thrombolysis over 4.5 hours. The medical data of patients with AIS in our center were retrospectively reviewed, and the data of the multimode CT-guided thrombolytic therapy or nonthrombolytic therapy within different time windows (3-9 hours) were evaluated. 134 AIS cases were selected successfully and divided into three groups: patients with AF treated by rt-PA (AF rt-PA), patients with AF not treated by rt-PA (AF non-rt-PA), and patients without AF treated by rt-PA (non-AF rt-PA). After correcting for the baseline NIH Stroke Scale (NIHSS), sex, age, and hypertension data, the comparison results showed that the NIHSS improved significantly at hospital discharge for rt-PA-treated patients (n = 47) compared to non-rt-PA-treated patients with AIS (n = 31) with AF (P = 0.0156). The NIHSS evaluation at 90 days of follow-up also improved in rt-PA-treated patients (P = 0.0157). The NIHSS at hospital discharge was higher in AF rt-PA-treated patients compared to non-AF rt-PAtreated patients (P = 0.0167) after correction; the difference was not statistically significant at 90 days of follow-up (P = 0.091). Our research showed that the neural function improved after 3-9 hours of thrombolytic therapy with rt-PA in patients with AIS and AF. If there is no thrombolytic taboo, the patients could benefit from the thrombolytic therapy, although the onset time window has been extended to 9 hours.

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

“…Heterogeneity existed in several statistical results in our study, for example, in mRS 0-1 at 90 days after stroke analysis, I 2 was 71.0%. By sensitivity analysis, heterogeneity was derived from two studies [14,15]. The causes of heterogeneity in these two studies were analyzed, one study [14] included more severe stroke (NIHSS > 10) patients, one study [14] included patients with a longer thrombolysis time window (3-9 h) than the others.…”

“…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).…”

“…Compare IS patients with and without AF, most of the studies showed that patients without AF had better 90-day functional outcomes receiving thrombolytic therapy than those with AF [5][6][7][8][9][10][11][12][13], a few studies hold the opposite conclusion [14][15]. 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].…”

“…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].…”