IV t-PA therapy in acute stroke patients with atrial fibrillation
Introduction
We previously reported that atrial fibrillation (AF) was observed in 21.1% of 15,831 acute ischemic stroke patients in the J-MUSIC study [1] and that AF was a predictive factor for severe stroke and early death [2]. Therefore, attention needs to be paid to the treatment of acute stroke patients with AF in order to improve patients' outcomes. Intravenous administration of tissue plasminogen activator (t-PA) can improve clinical outcomes in patients with acute ischemic stroke [3], [4]. Early arterial recanalization has been recognized as a marker of a good outcome after t-PA infusion [5], [6], [7], [8], [9], [10]. Using transcranial Doppler (TCD) examination Alexandrov et al. [11] reported that, during t-PA infusion, recanalization was complete in 30% and partial in 40% of patients. Recently, we reported that AF was independently associated with a lack of early recanalization after t-PA administration [12]. Furthermore, using the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Trial, [3] subanalysis reveled that AF was associated with poor outcome after t-PA therapy [13]. Brown et al. reported that AF was not related with major neurological improvement within 24 h after t-PA infusion [14]. Therefore, we hypothesized that acute stroke patients with AF were less likely to respond to t-PA therapy compared with those without AF. We investigated clinical characteristics and patient outcome after t-PA therapy in acute stroke patients with and without AF.
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Subjects and methods
Consecutive patients with acute ischemic stroke treated with t-PA within 3 h of stroke onset between October 2005 and August 2008 were studied prospectively. Patients with heart valve replacements, pacemakers, or cranial artery clipping were excluded, since MRI is contraindicated in these patients.
The following clinical data were collected from all patients: 1) patient age and gender; 2) arterial blood pressure before t-PA infusion; 3) NIHSS score before and 7 days after t-PA infusion; 4) the
Results
A total of 86 consecutive stroke patients were treated with t-PA. One patient was excluded because of having a pacemaker. Thus, 85 patients (56 males, 29 females; mean age, 73.4 ± 11.5 years) were enrolled in the present study. The time from symptom onset to the initial MRI study was 93.6 ± 31.3 min, and the time from symptom onset to the t-PA bolus was 148.0 ± 26.2 min. The baseline NIHSS score was 14.9 ± 7.4.
44 (51.8%) patients (AF group) had AF and 41 (48.2%) patients (Non-AF group) did not have
Discussion
The present study found that acute ischemic stroke patients with AF more frequently had poor outcome after IV-t-PA therapy compared with those without AF. Early arterial recanalization has been recognized as a marker of good outcome after t-PA infusion [5], [6], [7], [8], [9], [10]. Molina et al. [8] reported that early recanalization was more frequent in patients with cardioembolic stroke than with other stroke types. They reported that 59% of cardioembolic strokes displayed recanalization.
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2020, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :They also found that lower rate of favorable outcome was observed in patient with AF after iv. thrombolysis than in the non-AF group.24 Although, we did not find a difference in the recanalization rate between the two groups, Hussain et al. found that patients with intracranial occlusions secondary to extracranial carotid stenosis or total occlusion appear to have more successful recanalization rate when treated with endovascular therapy compared with those with cardioembolic occlusions.25
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2018, Neurologia i Neurochirurgia PolskaCitation Excerpt :Previous observations do not allow for a clear identification of the importance of AF for the effect of thrombolytic therapy, especially in the acute phase of disease. Results of several studies suggest a worse clinical effect and lower safety of rt-PA application in patients with AF; however, it is difficult to draw consistent conclusions due to the differences in study protocols [10–13]. It has been indicated that there was a lower percentage for the recanalization of arteries in the patients with AF treated with rt-PA compared to the patients without AF [10].