Abstract
BackgroundThe efficacy and safety of intravenous thrombolysis (IVT) for acute ischemic stroke with atrial fibrillation (AF) is still controversial.MethodsWe conducted a meta-analysis of all relevant studies, retrieved through systematic search of PubMed, Embase, and Cochrane databases up to December 31, 2019. Modified Rankin Scale (mRS) scores of 0–1 at 90 days, mRS of 0–2 at 90 days, overall mortality, and incidence of symptomatic intracranial hemorrhage (sICH) were collected as outcome measures. Fixed- and random-effects meta-analytical models were applied, and between-study heterogeneity was assessed.ResultsA total of 8509 patients were enrolled in 18 studies. A comparison of IVT treatment in AF versus non-AF patients showed that AF was associated with a significantly lower proportion of patients with mRS of 0–1 (24.1% vs. 34.5%; OR 0.59; 95% CI 0.43–0.81; P < 0.001), mRS of 0–2 (33.6% vs. 47.8%; OR 0.55; 95% CI 0.43–0.70; P < 0.001), as well as significantly higher mortality (19.4% vs. 11.5%; OR 2.05; 95% CI 1.79–2.36; P < 0.001) and higher incidence of sICH (6.4% vs. 4.1%; OR 1.60; 95% CI 1.27–2.01; P < 0.001). A comparison of AF patients who were subjected or not to IVT showed that thrombolysis carried a higher risk of sICH (5.7% vs. 1.6%; OR 3.44; 95% CI 2.04–5.82; P < 0.001) and was not associated with a better prognosis. Subgroup analysis in prospective studies also suggested a poorer functional prognosis and higher mortality in AF patients treated with IVT compared with those who did not receive IVT. Some heterogeneity was present in this meta-analysis.ConclusionsAcute IS patients with AF had worse outcomes than those without AF after thrombolytic therapy, and had a higher incidence of sICH after thrombolysis than those without thrombolysis. Thrombolysis in ischemic stroke patients with AF should be carefully considered based on clinical factors such as NIHSS score, age, and the type of AF.
Highlights
The efficacy and safety of intravenous thrombolysis (IVT) for acute ischemic stroke with atrial fibrillation (AF) is still controversial
Studies were considered to be potentially eligible for this meta-analysis if they met the following criteria: (1) they compared the efficacy and safety of thrombolysis in AF versus non-AF patients; (2) they measured the efficacy and safety of IVT in AF patients and compared the outcome with AF patients not treated with IVT; (3) they included sufficient data on the modified Rankin Scale 0–1 and Modified Rankin Scale (mRS) 0–2, mortality and the incidence of symptomatic intracranial hemorrhage
Based on the search criteria, a total of 18 studies reporting on the efficacy and safety of thrombolysis for acute ischemic stroke (IS) with AF were included in this study (Fig. 1)
Summary
The efficacy and safety of intravenous thrombolysis (IVT) for acute ischemic stroke with atrial fibrillation (AF) is still controversial. Intravenous thrombolysis (IVT) in acute IS patients within 4.5 h of onset can significantly improve functional outcome and reduce the risk of death and severe disability from stroke [4]. When comparing AF patients treated or not with IVT, some studies indicate that IVT is associated with much better functional outcomes [7, 9, 15, 20, 21]. Two studies reported higher mortality [5, 11] Due to these controversial results, we performed a meta-analysis of all relevant studies measuring the efficacy and safety of thrombolytic therapy for acute IS patients with AF
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
