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Atrial fibrillation in ischemic stroke: predicting response to thrombolysis and clinical outcomes

Gustavo Saposnik1, David Gladstone, Roula Raptis

  • 1MSc, FAHA, FRCPC, Stroke Outcomes Research Center, Department of Medicine, St. Michael's Hospital, University of Toronto, 55 Queen St E, Toronto, Ontario, M5C 1R6, Canada. saposnikg@smh.ca

Stroke
|November 22, 2012
PubMed

Insights

Patients with atrial fibrillation (AF) face higher stroke mortality and hemorrhage risk. Thrombolysis showed no benefit for AF patients, unlike those without AF.

Area of Science:

  • Neurology
  • Cardiology
  • Public Health

Background:

  • Atrial fibrillation (AF) is a significant risk factor for stroke.
  • AF is associated with poorer stroke outcomes and limited tools for evaluating treatment efficacy.
  • Assessing clinical outcomes in AF stroke patients receiving thrombolysis is crucial.

Purpose of the Study:

  • To evaluate the effectiveness of thrombolysis in acute ischemic stroke patients with and without atrial fibrillation.
  • To assess clinical outcomes, including favorable outcomes, intracerebral hemorrhage, and mortality, in stroke patients with AF.
  • To investigate the role of the iScore in predicting outcomes for stroke patients with AF.

Main Methods:

  • Applied the validated iScore risk assessment tool to acute ischemic stroke patients.
  • Analyzed data from the Registry of the Canadian Stroke Network.
  • Defined favorable outcome as modified Rankin scale 0-2 at discharge; secondary outcomes included intracerebral hemorrhage and mortality.

Main Results:

  • 17.2% of acute ischemic stroke patients had AF, exhibiting higher mortality and disability rates.
  • Thrombolysis improved outcomes in non-AF patients but showed no benefit in AF patients.
  • AF patients had a modestly increased risk of intracranial hemorrhage post-thrombolysis.

Conclusions:

  • Stroke patients with AF experience higher mortality and intracerebral hemorrhage risk.
  • Thrombolysis response in AF stroke patients is similar to non-AF patients, with no observed benefit.
  • The iScore interacts with tPA treatment for favorable outcomes, particularly in non-AF patients.
Abstract

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