Rt-PA Intravenous Thrombolysis In Acute Ischemic Stroke Patients With Atrial Fibrillation

ObjectionThe outcome of intravenous thrombolysis (i.v.) for ischemic stroke patients with atrial fibrillation (AF) was worse than ischemic stroke patients without AF within 4.5 h. Currently some researches confirmed the effectiveness of ischemic stroke patients with AF after intravenous thrombolytic therapy, but still not yet entirely clearly. This study aimed to further investigate the primary outcome and influencing factors about the outcome of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis about ischemic stroke with AF in china.MethodThe study was initiated by Jiangsu Stroke Research Collaborative Group, in total collected 267 ischemic stroke patients with atrial fibrillation between November 2009 and July 2013 from 15 hospitals in Jiangsu Province. The time from symptoms onset to hospitalization were all within 4.5 hours.151 of the patients got the intravenous rt-PA thrombolytic therapy in acute phase (treatment group), and the other 116 patients in acute phase did not undergo thrombolytic therapy (control group). The collected information included:baseline data such as age, sex, smoking and drinking history, diabetes, hypertension, hyperlipidemia, congestive heart failure, history of stroke, systolic blood pressure, diastolic blood pressure, blood sugar, NIHSS score, time from onset to hospitalization, with anticoagulant medication within the late 48 hours; The patients performed CT scan for eliminate bleeding after treatment 24 hours, the relationship of hemorrhage and symptoms worsen, NIHSS at discharge, mRS at 3-month. The treatment method was given intravenous rt-PA thrombolysis within 4.5 hours in thrombolysis group(at a dose of 0.9mg/kg, not to exceed a total dose of 90mg, 10% intravenous injection, and the remaining 90% within 60 minutes of intravenous slow trickle). Anticoagulant therapy was given if no bleeding by CT performed after thrombolysis 24 hours, control group was given anticoagulant therapy after hospitalization. And the safety endpoint was the occurrence of hemorrhagic transformation after thrombolytic 24h and 3-month mortality, the efficacy endpoint events was good prognosis (mRS 0-1) at 3-month. In addition, we analyzed the risk factors affecting favorable (mRS 0-1) outcome.Results1、Without smoking (p=0.000),we found no difference between thrombolysis treatment group and control group.2、The rt-PA treatment group had a better outcome than the control group at 3-month (p=0.038)3、Thrombolysis was independently associated with the favorable outcome (p< 0.000). With congestive heart failure, higher systolic pressure, higher NIHSS at admission were the risk factors of favorable stroke outcome (p<0.05)4、But, patients with congestive heart failure, normal blood pressure, and lower or higher NIHSS score could benefit from thrombolysis (p<0.05)ConclusionIschemic stroke patients with AF got benefits from intravenous thrombolysis with rt-PA within 4.5 h after stroke, especially, with congestive heart failure or normal blood pressure. This suggests that these patients may get active intravenous thrombolytic therapy aggressively and immediately.