IV t-PA therapy in acute stroke patients with atrial fibrillation.
OBJECTIVE
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Kimura
Kazumi
K
Department of Stroke Medicine, Kawasaki Medical School, Kurashiki City, Okayama, Japan. kimurak@med.kawasaki-m.ac.jp
Iguchi
Yasuyuki
Y
Shibazaki
Kensaku
K
Iwanaga
Takeshi
T
Yamashita
Shinji
S
Aoki
Junya
J
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous / Q000379:methods; D008297:Male; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
D010959:Tissue Plasminogen Activator