Background and purpose
Atrial fibrillation (AF) is a predictor for severe stroke. Intravenous administration of tissue plasminogen activator (t-PA) can improve clinical outcomes in patients with acute ischemic stroke. We investigated clinical characteristics and patient outcome in patients with and without AF after t-PA therapy.
Consecutive ischemic stroke patients treated with t-PA within 3 h of stroke onset were studied prospectively. MRI examinations, including diffusion weighted imaging and MRA, were performed before t-PA thrombolysis. NIHSS scores were obtained before and 7 days after t-PA infusion. The patients were divided into two groups (AF group and Non-AF group). Their clinical characteristics and outcome 7 days and 3 months after t-PA therapy were compared.
85 patients (56 males, mean age, 73.4±11.5 years) were enrolled in the present study. The AF-group had 44 patients, and the Non-AF group had 41 patients. Fewer patients with AF had dramatic improvement at 7 days and favorable outcome (mRS 0–1) at 3 months after t-PA therapy than patients without AF (31.8% vs. 61.0%, P=0.007, and 15.9% vs. 46.3%, P=0.002). On the other hand, worsening at 7 days and poor outcome (mRS >3 and death) at 3 months after t-PA therapy were more frequently observed in AF group than Non-AF group (22.7% vs. 9.8%, P=0.107, and 70.5% vs. 41.5%, P=0.007). After adjusting age and gender, patients with AF more frequently had worsening and poor outcome than those without AF (adjusted OR; 4.54, 95% CI 1.04–19.75, P=0.044, and adjusted OR; 2.8, 95% CI 1.10–7.28, P=0.032).
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.
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- Analysis of 16,922 patients with acute ischemic stroke and transient ischemic attack in Japan. A hospital-based prospective registration study.Cerebrovasc Dis. 2004; 18: 47-56
- Atrial fibrillation as a predictive factor for severe stroke and early death in 15,831 patients with acute ischaemic stroke.J Neurol Neurosurg Psychiatry. 2005; 76: 679-683
- Tissue plasminogen activator for acute ischemic stroke.N Engl J Med. 1995; 333: 1581-1587
- Association of outcome with early stroke treatment: pooled analysis of atlantis, ecass, and ninds rt-PA stroke trials.Lancet. 2004; 363: 768-774
- Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke.Ann Neurol. 1992; 32: 78-86
- Speed of tPA-induced clot lysis predicts dwi lesion evolution in acute stroke.Stroke. 2007; 38: 955-960
- Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion.Stroke. 2005; 36: 869-871
- Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator.Stroke. 2004; 35: 151-156
- Predictors of early arterial reocclusion after tissue plasminogen activator-induced recanalization in acute ischemic stroke.Stroke. 2005; 36: 1452-1456
- Recanalization after thrombolysis in stroke patients: predictors and prognostic implications.Neurology. 2007; 68: 39-44
- High rate of complete recanalization and dramatic clinical recovery during tPA infusion when continuously monitored with 2-MHZ transcranial Doppler monitoring.Stroke. 2000; 31: 610-614
- Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke.J Neurol Sci. 2008; 267: 57-61
- Predicting prognosis after stroke: a placebo group analysis from the national institute of neurological disorders and stroke rt-PA stroke trial.Neurology. 2000; 55: 952-959
- Predicting major neurological improvement with intravenous recombinant tissue plasminogen activator treatment of stroke.Stroke. 2004; 35: 147-150
- Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan alteplase clinical trial (J-ACT).Stroke. 2006; 37: 1810-1815
- Serum glucose level and diabetes predict tissue plasminogen activator-related intracerebral hemorrhage in acute ischemic stroke.Stroke. 1999; 30: 34-39
- Histopathological evaluation of left atrial appendage thrombogenesis removed during surgery for atrial fibrillation.Am Heart J. 2007; 153: 704-711
- Relation of atrial fibrillation and high haematocrit to mortality in acute stroke.Lancet. 1983; 1: 784-786
- Cardiogenic brain embolism.Arch Neurol. 1986; 43: 71-84
- Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns.Neurology. 1998; 50: 341-350
- Clinical and vascular outcome in internal carotid artery versus middle cerebral artery occlusions after intravenous tissue plasminogen activator.Stroke. 2002; 33: 2066-2071
- Tandem internal carotid artery/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis.Stroke. 2006; 37: 2301-2305
- Site of arterial occlusion identified by transcranial Doppler predicts the response to intravenous thrombolysis for stroke.Stroke. 2007; 38: 948-954
- Prevalence and clinical characteristics of patients with atrial fibrillation: analysis of 20,000 cases in Japan.Jpn Circ J. 2000; 64: 653-658
- Reliability and validity of noninvasive imaging of internal carotid artery pseudo-occlusion.Stroke. 1999; 30: 1444-1449
Accepted: October 21, 2008
Received in revised form: October 19, 2008
Received: September 1, 2008
© 2008 Published by Elsevier Inc. All rights reserved.