Thrombolysis with alteplase for acute ischemic stroke patients with atrial fibrillation.
OBJECTIVE
Intravenous administration of recombinant tissue plasminogen activator (rtPA) is known as the only approved treatment for acute ischemic stroke. However, it is still controversial whether acute ischemic stroke patients with atrial fibrillation should receive rtPA therapy.


METHODS
We studied 99 patients altogether who belonged to three different groups based on the patient characteristics: (1) atrial fibrillation rtPA-treated group consisting of 22 ischemic stroke patients with atrial fibrillation treated with rtPA within 4.5 hours after the onset of stroke; (2) atrial fibrillation non-rtPA-treated group consisting of 44 acute ischemic stroke patients with atrial fibrillation matching in age and baseline National Institutes of Health Stroke Scale (NIHSS); (3) the non-atrial fibrillation rtPA-treated group consisting of 33 patients without atrial fibrillation treated with rtPA.


RESULTS
The median time for the administration of rtPA was 199.6 +/- 50.0 minutes. More patients had favorable outcomes (90 day modified Rankin Scale 0-1) in the atrial fibrillation rtPA-treated group than the atrial fibrillation non-rtPA-treated group (36.4 versus 13.6%; odds ratio=2.667; 95% confidence interval: 1.056-6.735; p=0.033). The mortality at day 90 was lower in the rtPA-treated group than the non-rtPA-treated group (18.2 versus 20.5%; p=0.827), although the incidence of symptomatic intracranial hemorrhage was higher (18.2 versus 6.8%; p=0.184). Patients in the atrial fibrillation rtPA-treated group had fewer favorable outcomes than non-atrial fibrillation rtPA-treated group (36.4 versus 51.6%; p=0.076), but their baseline NIHSS was higher (12.0 +/- 7.1 versus 9.1 +/- 7.3; p=0.161).


CONCLUSIONS
As compared with non-rtPA-treated patients, rtPA treated within 4.5 hours after the onset of stroke significantly improved clinical outcomes in atrial fibrillation patients. Thrombolytic treatment increases intracranial hemorrhage rate but does not increase mortality.
Zhang
Jing-Bo
JB
Department of Neurology, The Third People's Hospital of Dalian, Dalian, China. dlzhangjingbo@163.com
Ding
Ze-Yu
ZY
Yang
Ying
Y
Sun
Wei
W
Hai
Feng
F
Sui
Xin-Ning
XN
Li
Xue-Yuan
XY
Wang
Hong-Zhi
HZ
Wang
Xin-Tao
XT
Zheng
Jin-Lian
JL
D000208:Acute Disease; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000097:blood* / Q000188:drug therapy* / Q000201:enzymology; D020767:Intracranial Thrombosis / Q000097:blood / Q000188:drug therapy / Q000201:enzymology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood* / Q000188:drug therapy* / Q000201:enzymology; D015912:Thrombolytic Therapy / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator