Skip to main content

Advertisement

SpringerLink
Log in

Factors Associated with Thrombolysis Outcome in Ischemic Stroke Patients with Atrial Fibrillation

  • Original Article
  • Published:
Neuroscience Bulletin Aims and scope Submit manuscript

Abstract

The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation (AF) is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-related ischemic stroke remains largely unknown. In this study, we investigated factors that influence the effect of intravenous thrombolysis in these patients. Our results showed that thrombolysis was independently associated with a favorable outcome (P < 0.001) and did not influence the mortality of AF-related ischemic stroke, although it increased the risk of hemorrhage within 24 h after treatment. Risk factors for a poor outcome at admission were: heart failure (P = 0.045); high systolic pressure (P = 0.039); high blood glucose (P = 0.030); and a high National Institutes of Health Stroke Scale (NIHSS) score (P < 0.001). Moreover, high systolic pressure at admission (P = 0.007), high blood glucose (P = 0.027), and a high NIHSS score (P < 0.001) were independent risk factors for mortality at 3 months. Besides thrombolysis, a high NIHSS score (P = 0.006) and warfarin taken within 48 h before stroke onset (P = 0.032) were also independent risk factors for symptomatic hemorrhage within 24 h after treatment. Ischemic stroke patients with AF benefited from intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010, 375: 1695–1703.

    Article  CAS  PubMed  Google Scholar 

  2. Asberg S, Henriksson KM, Farahmand B, Asplund K, Norrving B, Appelros P,et al. Ischemic stroke and secondary prevention in clinical practice: a cohort study of 14,529 patients in the Swedish Stroke Register. Stroke 2010, 41: 1338–1342.

    Article  PubMed  Google Scholar 

  3. Saposnik G, Gladstone D, Raptis R, Zhou L, Hart RG, et al. Atrial fibrillation in ischemic stroke: predicting response to thrombolysis and clinical outcomes. Stroke 2013, 44: 99–104.

    Article  PubMed  Google Scholar 

  4. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008, 359: 1317–1329.

    Article  CAS  PubMed  Google Scholar 

  5. Chen C, Ye M,Chen BL, Chen GF, Gao ZQ, Zhou JS, et al. Thrombolysis on Ischemic Stroke Patients with Decreased Level of Consciousness within 4.5 h. CNS Neurosci Ther 2013, 9: 48–52.

    Article  Google Scholar 

  6. Frank B, Fulton R, Weimar C, Shuaib A, Lees KR, et al. Impact of atrial fibrillation on outcome in thrombolyzed patients with stroke: evidence from the Virtual International Stroke Trials Archive (VISTA). Stroke 2012, 3: 1872–1877.

    Article  Google Scholar 

  7. Padjen V, Bodenant M, Jovanovic DR, Ponchelle-Dequatre N, Novakovic N, Cordonnier C, et al. Outcome of patients with atrial fibrillation after intravenous thrombolysis for cerebral ischaemia. J Neurol 2013, 260: 3049–3054.

    Article  PubMed  Google Scholar 

  8. Kimura K, Iguchi Y, Shibazaki K, Iwanaga T, Yamashita S, Aoki J, et al. IV t-PA therapy in acute stroke patients with atrial fibrillation. J NeurolSci 2009, 276: 6–8.

    CAS  Google Scholar 

  9. Sanak D, Herzig R, Kral M, Bártková A, Zapletalová J, Hutyra M, et al. Is atrial fibrillation associated with poor outcome after thrombolysis? J Neurol 2010, 257: 999–1003.

    Article  PubMed  Google Scholar 

  10. Zhang JB, Ding ZY, Yang Y, Sun W, Hai F, Sui XN, et al. Thrombolysis with alteplase for acute ischemic stroke patients with atrial fibrillation. Neurol Res 2010, 32: 353–358.

    Article  PubMed  Google Scholar 

  11. Christou I, Alexandrov AV, Burgin WS, Wojner AW, Felberg RA, Malkoff M, et al. Timing of recanalization after tissue plasminogen activator therapy determined by transcranialdoppler correlates with clinical recovery from ischemic stroke. Stroke 2000, 31: 1812–1816.

    Article  CAS  PubMed  Google Scholar 

  12. Generalized efficacy of t-PA for acute stroke. Subgroup analysis of the NINDS t-PA Stroke Trial. Stroke 1997, 28: 2119–2125.

    Article  Google Scholar 

  13. Bluhmki E, Chamorro A, Davalos A, Machnig T, Sauce C, Wahlgren N, et al. Stroke treatment with alteplase given 3.0-4.5 h after onset of acute ischaemic stroke (ECASS III): additional outcomes and subgroup analysis of a randomised controlled trial. Lancet Neurol 2009, 8: 1095–1102.

    Article  CAS  PubMed  Google Scholar 

  14. Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G, Murray G, et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomized controlled trial. Lancet 2012, 379: 2352–2363.

    Article  PubMed  Google Scholar 

  15. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation 2003, 107: 2920–2925.

    Article  PubMed  Google Scholar 

  16. Wahlgren N, Ahmed N, Eriksson N, Aichner F, Bluhmki E, Dávalos A, et al. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials: Safe Implementation of Thrombolysis in Stroke-Monitoring STudy (SITS-MOST). Stroke 2008, 39: 3316–3322.

    Article  PubMed  Google Scholar 

  17. Kufner A, Nolte CH, Galinovic I, Brunecker P, Kufner GM, Endres M, et al. Smoking-thrombolysis paradox: recanalization and reperfusion rates after intravenous tissue plasminogen activator in smokers with ischemic stroke. Stroke 2013, 44: 407–413.

    Article  CAS  PubMed  Google Scholar 

  18. Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA 1999, 282: 2019–2026.

    Article  CAS  PubMed  Google Scholar 

  19. Davis SM, Donnan GA, Parsons MW, Levi C, Butcher KS, Peeters A, et al. Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial. Lancet Neurol 2008, 7: 299-309.

    Article  PubMed  Google Scholar 

  20. Yingqi Xing, Zhen-Ni Guo, Yi Yang, Jin H, Wang S, Yang Y, et al. Increased globulin and its association with hemorrhagic transformation in patients receiving intra-arterial thrombolysis therapy. Neurosci Bull 2014, 6: 469–476.

    Article  Google Scholar 

  21. Delgado-Mederos R, Rovira A, Alvarez-Sabin J, Ribó M, Munuera J, Rubiera M, et al. Speed of tPA-induced clotlysis predicts DWI lesion evolution in acute stroke. Stroke 2007, 38: 955–960.

    Article  CAS  PubMed  Google Scholar 

  22. Kim YS, Garami Z, Mikulik R, et al. Early recanalization rates and clinical outcomes in patients with tandem internal carotid artery/middle cerebral artery occlusion and isolated middle cerebral artery occlusion. Stroke 2005, 36: 869–871.

    Article  PubMed  Google Scholar 

  23. Zangerle A, Kiechl S, Spiegel M, Molina CA, Alexandrov AV, et al. Recanalization after thrombolysis in stroke patients: predictors and prognostic implications. Neurology 2007, 68: 39–44.

    Article  CAS  PubMed  Google Scholar 

  24. Seet R C S, Zhang Y, Wijdicks E F, Rabinstein AA, et al. Relationship between chronic atrial fibrillation and worse outcomes in stroke patients after intravenous thrombolysis. Arch Neurol 2011, 68: 1454–1458.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the National Natural Science Foundation of China (81230026 and 81171085), the Natural Science Foundation of Jiangsu Province, China (BL2012013), and the Science Foundation of the Bureau of Health of Jiangsu Province, China (LJ201101).

Author information

Author notes

    Authors and Affiliations

    1. Department of Neurology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, 210008, China

      Qiuyun Zhao, Meijuan Zhang & Yun Xu

    2. Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China

      Qiuyun Zhao

    3. Jiangsu Stroke Research Collaborative Group, Nanjing, 210008, China

      Qiuyun Zhao, Xiaobo Li, Wanli Dong, Min Ye, Yongjun Cao, Meijuan Zhang, Qiantao Cheng, Junshan Zhou, Guofang Chen, Ming Yu, Shanshan Hong, Xiue Wei, Bei Wang, Guiyun Cui, Peng Zhang, Hong Ding, Rongzhen Xu, Yan Chen & Yun Xu

    4. Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing, 210008, China

      Qiuyun Zhao, Meijuan Zhang, Yan Chen & Yun Xu

    5. Department of Neurology, Northern Jiangsu People’s Hospital, Yangzhou, 225001, China

      Xiaobo Li

    6. Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China

      Wanli Dong

    7. Department of Neurology, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing, 210019, China

      Min Ye

    8. Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China

      Yongjun Cao

    9. Department of Neurology, The Affiliated Huaian First People’s Hospital of Nanjing Medical University, Huaian, 223300, China

      Qiantao Cheng

    10. Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China

      Junshan Zhou

    11. Department of Neurology, Affiliated Xuzhou Central Hospital of Xuzhou Medical College, Xuzhou, 221009, China

      Guofang Chen

    12. Department of Neurology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212002, China

      Ming Yu

    13. Department of Neurology, Jiangyin People’s Hospital, Jiangyin, 214400, China

      Shanshan Hong

    14. Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical College, Xuzhou, 221006, China

      Xiue Wei

    15. Department of Neurology, The First People’s Hospital of Lianyungang, Lianyungang, 222002, China

      Bei Wang

    16. Department of Neurology, The First Affiliated Hospital of Xuzhou Medical College, Xuzhou, 221000, China

      Guiyun Cui

    17. Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, 210003, China

      Peng Zhang & Hong Ding

    18. Department of Neurology, Gaochun People’s Hospital, Nanjing, 211300, China

      Rongzhen Xu

    19. Department of Neurology, Drum Tower Hospital of Nanjing Medical University, Nanjing, 210008, China

      Yan Chen

    20. Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing, 210008, China

      Yun Xu

    Authors
    1. Qiuyun Zhao
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Xiaobo Li
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Wanli Dong
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Min Ye
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Yongjun Cao
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Meijuan Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Qiantao Cheng
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Junshan Zhou
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. Guofang Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Ming Yu
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Shanshan Hong
      View author publications

      You can also search for this author in PubMed Google Scholar

    12. Xiue Wei
      View author publications

      You can also search for this author in PubMed Google Scholar

    13. Bei Wang
      View author publications

      You can also search for this author in PubMed Google Scholar

    14. Guiyun Cui
      View author publications

      You can also search for this author in PubMed Google Scholar

    15. Peng Zhang
      View author publications

      You can also search for this author in PubMed Google Scholar

    16. Hong Ding
      View author publications

      You can also search for this author in PubMed Google Scholar

    17. Rongzhen Xu
      View author publications

      You can also search for this author in PubMed Google Scholar

    18. Yan Chen
      View author publications

      You can also search for this author in PubMed Google Scholar

    19. Yun Xu
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding authors

    Correspondence to Yan Chen or Yun Xu.

    Additional information

    Qiuyun Zhao, Xiaobo Li, Wanli Dong, and Min Ye contributed equally to this work.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Zhao, Q., Li, X., Dong, W. et al. Factors Associated with Thrombolysis Outcome in Ischemic Stroke Patients with Atrial Fibrillation. Neurosci. Bull. 32, 145–152 (2016). https://doi.org/10.1007/s12264-016-0019-8

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s12264-016-0019-8

    Keywords

    Search

    Navigation