Abstract TMP75: Atrial Fibrillation In Ischemic Stroke: Predicting Response To Thrombolysis And Clinical Outcomes

Abstract

Background: Atrial fibrillation (AF) increases the risk of stroke and is associated with poorer stroke outcomes. Few tools are available to evaluate clinical outcomes and response to thrombolysis in stroke patients with AF. Methods: We applied the iScore ( www.sorcan.ca/iscore ), a validated risk score, to consecutive patients with an acute ischemic stroke participating in the RCSN. The main outcome was the proportion of patients with a favorable outcome (defined as a modified Rankin scale 0-2) at discharge after thrombolysis. Secondary outcomes included death at 30-days and at 1-year stratified by terciles of the iScore. Results: Among 12,686 patients with an acute ischemic stroke, 2,185 (17.2%) had AF. Among patients in the highest iScore tercile, those with AF had higher mortality at 30 days (34.7% vs.28.2%; p<.001) and at 1-year (53.6% vs.45.0%; p3) at discharge (RR 1.26, 95%CI 1.18-1.33; Figure 1) and an increased risk of intracranial hemorrhage (any type) (16.5% vs. 13.1%; RR 1.42, 95%CI 1.05-1.91) after thrombolysis. In the Poisson regression analysis, the benefit of tPA declined more rapidly at lower iScore values among AF patients than for others (p-value for interaction <0.001; Figure 2). Conclusion: The iScore predicted a differential response after tPA between patients with and without AF. Stroke patients with AF have higher mortality, greater risk of ICH, and reduced response to thrombolysis compared with non-AF patients for a given high iScore. Figure 1 Figure 2

Comparison of Different Dosages of Alteplase in Atrial Fibrillation–Related Acute Ischemic Stroke After Intravenous Thrombolysis: A Nationwide, Multicenter, Prospective Cohort Study in Taiwan

“…Our measurements for functional status are consistent with most studies, 49 , 50 , 51 , 52 , 53 , 54 , 55 reporting that patients with AF tended to have unfavorable functional outcomes at 90 days before adjustment for any covariates. Consistent with previous studies, 51 , 52 , 53 , 54 our results revealed that the trend of unfavorable outcomes in patients with AF was eliminated after adjustment for the baseline NIHSS scores and other demographic characteristics. By contrast, a recent meta‐analysis in 2021 12 reported that patients with AF had poorer functional outcomes at 90 days and higher SICH rates than patients without AF.…”

“…First, this study included a larger prospective cohort of patients with and without AF ever treated with IVT than that in previous studies. 49 , 50 , 51 , 52 , 53 , 54 , 55 Second, a solid definition for hemorrhagic transformation was adopted based on NINDS, ECASS II, and SITS‐MOST standards to differentiate between varying severity levels of SICH. Third, by replacing the THRIVE score with the HAT score, SITS‐SICH score, SEDAN score, Cucchiara score, SPAN‐100 Index, and GRASPS score, our study validated the robustness of the primary and secondary objectives.…”

Disappearance of the Hyperdense Mca Sign after Stroke Thrombolysis: Implications for Prognosis and Early Patient Selection for Clot Retrieval

“…1,5 However we found no evidence for this, in keeping with larger studies demonstrating no differential effect of thrombolysis on cardioembolic compared to non-cardioembolic strokes. 19,20 Similar to our findings, a recent study found no difference in HU ratio or early recovery depending on whether the aetiology of thrombus was thought to be cardioembolic or atherothrombotic. 9 The significant trend towards reduced parenchymal haemorrhage we observed in patients with HMCAS disappearance is likely due to the smaller ischaemic volume, represented by higher ASPECTS scores and reduced stroke severity.…”

Factors Associated with Unfavorable Functional Outcomes After Intravenous Thrombolysis in Patients with Acute Ischemic Stroke

“… 24 Saposnik et al included 12,686 patients found that AF patients had a higher risk of death at 30-day, 1-year, and death or disability at discharge more than non-AF patients. 26 A meta-analysis of 8509 patients not only found the same trend as the previous study but also found that AF with stroke increases the risk of ICH due to large infarct size, poor collateral circulation, and large or old thrombi, which lead to IVT resistance, some AF patients may receive the anticoagulant drug before IVT which will increase bleeding risk. 23 Cardioembolism due to AF was recognized as one of the predictors for early parenchymal hemorrhagic transformation, related to unfavorable outcomes following IVT.…”