title: Thrombolysis with alteplase for acute ischemic stroke patients with atrial fibrillation.
abstract: 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.
authors.affiliation: Department of Neurology, The Third People's Hospital of Dalian, Dalian, China. dlzhangjingbo@163.com
authors.forename: Jing-Bo
authors.initials: JB
authors.lastname: Zhang
authors.forename: Ze-Yu
authors.initials: ZY
authors.lastname: Ding
authors.forename: Ying
authors.initials: Y
authors.lastname: Yang
authors.forename: Wei
authors.initials: W
authors.lastname: Sun
authors.forename: Feng
authors.initials: F
authors.lastname: Hai
authors.forename: Xin-Ning
authors.initials: XN
authors.lastname: Sui
authors.forename: Xue-Yuan
authors.initials: XY
authors.lastname: Li
authors.forename: Hong-Zhi
authors.initials: HZ
authors.lastname: Wang
authors.forename: Xin-Tao
authors.initials: XT
authors.lastname: Wang
authors.forename: Jin-Lian
authors.initials: JL
authors.lastname: Zheng
mesh_terms: 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
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator