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Outcome of patients with atrial fibrillation after intravenous thrombolysis for cerebral ischaemia

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Abstract

The question of whether i.v. rt-PA is beneficial in patients with ischaemic stroke and atrial fibrillation (AF) remains unresolved. Our objective was to evaluate the outcome of patients with AF who received i.v. rt-PA for stroke in the registries of Lille (France) and Belgrade (Serbia). End-points were poor outcome [modified Rankin Scale (mRS) 3–6], and symptomatic haemorrhagic transformation (sHT) according to ECASS3. Of 734 consecutive patients, 155 (21.2 %) had AF. The unadjusted comparison found patients with AF to be 12 years older, more likely to be women, to have hypertension, and baseline INR > 1.2, and less likely to be smokers. They had higher baseline NIHSS scores, diastolic blood pressure, and serum glucose concentrations, and lower platelet counts. They did not differ for sHT (5.8 vs. 5.5 %; p = 0.893), but they more frequently had poor outcomes (52.3 vs. 35.2 %; p < 0.001) and death (21.9 vs. 9.0 %; p < 0.001). The only independent predictor of sHT was baseline NIHSS (adjOR 1.05 per 1 point increase; 95 % CI 1.01–1.10). Independent variables associated with poor outcome were age (adjOR 1.04 for 1 year increase; 95 % CI 1.03–1.06), baseline NIHSS (adjOR 1.17 per 1 point increase; 95 % CI 1.13–1.21), and sHT (adjOR 47.6; 95 % CI 10.2–250) but not AF. In patients treated with i.v. rt-PA for cerebral ischaemia, those with AF have worse outcomes because they are older and have more severe strokes at admission. This result suggests that we should focus on prevention and research of more aggressive strategies at the acute stage.

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Acknowledgments

We are grateful to those who contributed to the collection of data and follow-up of the patients: Ivana Berisavac, Anne-Marie Bordet, Stéphanie Debette, Dominique Deplanque, Frédéric Dumont, Marko Ercegovac, Marie Girot, Hilde Hénon, Catherine Lefebvre, Christian Lucas, Costanza Rossi, Olivera Savic, Predrag Stanarcevic, Maja Stefanovic-Budimkic.

Conflicts of interest

Charlotte Cordonnier and Didier Leys have been investigators for the ECASS3 trial. The other authors declare no disclosure in relation with this manuscript.

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Authors and Affiliations

  1. Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia

    Visnja Padjen, Dejana R. Jovanovic & Ljiljana Beslac-Bumbasirevic

  2. School of Medicine, University of Belgrade, Belgrade, Serbia

    Visnja Padjen, Dejana R. Jovanovic & Ljiljana Beslac-Bumbasirevic

  3. Mathematical Institute, Serbian Academy of Sciences and Arts, Belgrade, Serbia

    Novak Novakovic

  4. Department of Neurology, Stroke Centre, Lille University Hospital, Lille, France

    Marie Bodenant, Nelly Ponchelle-Dequatre, Charlotte Cordonnier & Didier Leys

  5. Univ Lille Nord de France, 1046, Lille, France

    Marie Bodenant, Nelly Ponchelle-Dequatre, Charlotte Cordonnier & Didier Leys

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  1. Visnja Padjen
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  2. Marie Bodenant
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Correspondence to Didier Leys.

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Padjen, V., Bodenant, M., Jovanovic, D.R. et al. Outcome of patients with atrial fibrillation after intravenous thrombolysis for cerebral ischaemia. J Neurol 260, 3049–3054 (2013). https://doi.org/10.1007/s00415-013-7119-4

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