title: Effect of intravenous thrombolysis on stroke associated with atrial fibrillation.
abstract: BACKGROUND
  Data based on randomized clinical trials regarding the efficacy and safety of intravenous thrombolysis (IVT) versus placebo or any other antithrombotic agent in the treatment of stroke associated with atrial fibrillation (AF) are unavailable.
  
  
  METHODS
  Prospectively collected data on AF-associated stroke patients treated in a 3-year period were analyzed to assess the effect of IVT treatment. Outcome measures were modified Rankin Scale (mRS) score for functional outcome, death, and symptomatic intracerebral hemorrhage (sICH).
  
  
  RESULTS
  Of 787 patients diagnosed with an acute ischemic stroke in the observed period, 131 (16.6%) had AF. Multivariate logistic regression analysis after adjustment for confounders demonstrated that independent predictors of excellent outcome (mRS 0-1) in patients with AF-associated stroke were lower baseline National Institutes of Health Stroke Scale [NIHSS] score (adjusted odds ratio [(adj)OR], .87; 95% confidence interval [CI], 0.81-.94; P = .000) and the use of IVT ((adj)OR, 5.31; 95% CI, 1.90-14.82; P = .001), whereas independent predictors of death were higher baseline NIHSS score ((adj)OR, 1.07; 95% CI, 1.02-1.12; P = .003), previous stroke ((adj)OR, 4.11; 95% CI, 1.49-11.35; P = .006), absence of IVT use ((adj)OR, .19; 95% CI, .05-.77; P = .021), sICH ((adj)OR, 18.52; 95% CI, 1.59-215.37; P = .020), and higher serum glucose levels ((adj)OR, 1.26; 95% CI, 1.06-1.50; P = .008). Thrombolyzed patients with AF were less severe at baseline and were less likely to have NIHSS >18. They were more likely to have excellent and good functional outcome (mRS 0-2) whereas less likely to have death as outcome at 3 months. Thrombolyzed AF patients had constantly lower probability of death regardless of the baseline NIHSS score values.
  
  
  CONCLUSIONS
  These results should encourage the use of IVT in AF-associated strokes.
authors.affiliation: Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia. Electronic address: visnja.padjen@hotmail.com.
authors.forename: Visnja
authors.initials: V
authors.lastname: Padjen
authors.affiliation: Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia.
authors.forename: Dejana
authors.initials: D
authors.lastname: Jovanovic
authors.affiliation: Medical Faculty, University of Belgrade, Belgrade, Serbia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Berisavac
authors.affiliation: Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia.
authors.forename: Marko
authors.initials: M
authors.lastname: Ercegovac
authors.affiliation: Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Maja
authors.initials: M
authors.lastname: Stefanovic Budimkic
authors.affiliation: Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Stanarcevic
authors.affiliation: Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Beslac Bumbasirevic
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications*; D002543:Cerebral Hemorrhage / Q000139:chemically induced / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects* / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Stroke; atrial fibrillation; intravenous thrombolysis; outcome