Atrial Fibrillation is Associated With Poor Outcomes in Thrombolyzed Patients With Acute Ischemic Stroke

Yue, Rongzheng; Li, Dongze; Yu, Jing; Li, Shuangshuang; Ma, Yan; Huang, Songmin; Zeng, Zhi; Zeng, Rui; Sun, Xiaolin

doi:10.1097/md.0000000000003054

Cited by 36 publications

(32 citation statements)

References 28 publications

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“…Presence of specific comorbidities can affect functional outcomes following stroke. For example, a meta-analysis of 12 longitudinal cohorts following stroke thrombolysis, comprising 14,801 patients, found that AF was associated with a reduced likelihood of favourable outcome (modified Rankin Scale ≤2) 27 .…”

Section: Functional Outcomesmentioning

confidence: 99%

Multimorbidity in Stroke

Gallacher

Jani

Hanlon

et al. 2019

Stroke

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Section: Functional Outcomesmentioning

confidence: 99%

Multimorbidity in Stroke

Gallacher

Jani

Hanlon

et al. 2019

Stroke

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“…IVT has been reported to increase the incidence of HT markedly [7]. Atrial fibrillation (AF) [8,9], National Institutes of Health Stroke Scale (NIHSS) score [10], blood glucose level [11], leukoaraiosis [12], dual antiplatelet agent treatment before IVT [13], and systolic blood pressure variability [14] are the predictors of HT after IVT.…”

Section: Introductionmentioning

confidence: 99%

High Neutrophil-to-Lymphocyte Ratio Predicts Hemorrhagic Transformation in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Liu

Yin

et al. 2020

International Journal of Hypertension

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Background. The relationship between the neutrophil-to-lymphocyte ratio (NLR) and hemorrhagic transformation (HT) in acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) remains unclear. This study assessed whether high NLR is associated with HT in this population. Methods. Data were prospectively collected for continuous patients with AIS treated with IVT and retrospectively analyzed. Clinical variables included age, sex, vascular risk factors, National Institutes of Health Stroke Scale (NIHSS) score, onset-to-treatment time, and initial hematologic and neuroimaging findings. HT was confirmed by imaging performed within 3 days after IVT. Symptomatic HT (sHT) was defined as NIHSS score increased by 4 points compared with that on admission according to previously published criteria. The NLR value was based on the blood examination before IVT, and high NLR was defined as ≥75th percentile. Results. The study included 285 patients (201 (70.5%) males, the mean age was 62.3 years (range 29–89)). Seventy-two (25.3%) patients presented with HT, including three (1.1%) with sHT. The median NLR was 2.700 (1.820–4.255, interquartile range). Seventy-one (24.9%) patients had a high NLR (≥4.255) on admission. Univariate analysis indicated that patients with HT had higher NIHSS scores (P<0.001), systolic blood pressure (SBP), platelet counts, lymphocyte counts, and NLR (P<0.05), as well as a greater prevalence of high NLR than those without HT (37.5% vs. 20.7% and P=0.004). Patients with HT were more likely to have hypertension and AF. As lymphocyte counts and high NLR were highly correlated, we used two logistic regression models. In model 1 (with high NLR), NIHSS score on admission (odds ratio (OR) = 1.110, 95% confidence interval (CI) = 1.015–1.044, and P=0.001), AF (OR = 3.986, 95% CI = 2.095–7.585, and P<0.001), and high NLR (OR = 2.078, 95% CI = 1.078–4.003, P=0.029, sensitivity 0.375, and specificity 0.793) were significant predictors of HT. In model 2 (with lymphocyte counts), NIHSS score on admission (OR = 1.111, 95% CI = 1.050–1.175, and P<0.001), AF (OR = 3.853, 95% CI = 2.048–7.248, and P<0.001), and lymphocyte counts (OR = 0.522, 95% CI = 0.333–0.819, and P=0.005) were significantly associated with HT. Conclusions. High NLR could be a useful marker for predicting HT in AIS patients after IVT.

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“…AF appears to be an independent risk factor of in-hospital mortality, length of hospital stay, and increased treatment costs in stroke patients [26]. Kimura [28]. With the increase of studies of thrombolysis in AF, we collected more evidence to compare the outcomes of thrombolysis in patients with AF and non-AF, and to compare the outcomes of thrombolytic and nonthrombolytic therapy in patients with AF.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of thrombolysis for acute ischemic stroke with atrial fibrillation: a meta-analysis

2020

Preprint

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Background The efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke with atrial fibrillation (AF) were controversial. Methods We performed a meta-analysis of all relevant studies retrieved by systematic searches of the, Embase, and Cochrane databases up to December 31, 2019. Modified Rankin Scale (mRS) scores 0–1 at 90 days, mRS 0–2 at 90 days, overall mortality, and symptomatic intracranial hemorrhage (sICH) incidence were collected as outcome measures. Fixed effects meta-analytical models were used, and between-study heterogeneity was assessed. Results A total of 8,509 patients were enrolled in eighteen studies. In AF IVT versus non-AF IVT studies, AF was associated with a significant decrease in the proportion of patients with mRS of 0–1 (24.1% vs. 34.5%; OR 0.57; 95% CI 0.50–0.65; P = 0.000), mRS of 0–2 (33.6% vs. 47.8%; OR 0.50; 95% CI 0.44–0.57; P = 0.000) and significant higher in mortality (19.4% vs. 11.5%; OR 2.05; 95% CI 1.79–2.36; P = 0.000) and sICH incidence (6.4% vs. 4.1%; OR 1.60; 95% CI 1.27–2.01; P = 0.000). In AF IVT versus AF non-IVT studies, thrombolysis carried a higher risk of sICH (5.7% vs. 1.6%; OR 3.44; 95% CI 2.04–5.82; P = 0.000) instead of a better prognosis. Subgroup analysis in prospective studies also suggested a poorer functional prognosis and higher mortality in AF patients treated IVT compared with non-IVT. Conclusion Patients with AF had worse outcomes than those without AF after thrombolytic therapy. Patients with AF had a higher incidence of sICH after thrombolysis than those without thrombolysis.

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Atrial Fibrillation is Associated With Poor Outcomes in Thrombolyzed Patients With Acute Ischemic Stroke

Cited by 36 publications

References 28 publications

Multimorbidity in Stroke

Multimorbidity in Stroke

High Neutrophil-to-Lymphocyte Ratio Predicts Hemorrhagic Transformation in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Efficacy and safety of thrombolysis for acute ischemic stroke with atrial fibrillation: a meta-analysis

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