Chronic a-fib associated with worse stroke outcomes after iv thrombolysis

January 01, 0001

Chronic a-fib associated with worse stroke outcomes after iv thrombolysis

These investigators from Singapore and the US investigated the contribution of atrial fibrillation (AF) to stroke outcomes in patients treated with intravenous recombinant tissue plasminogen activator in a retrospective cohort study. Main outcome measures were symptomatic intracranial hemorrhage and poor functional recovery (modified Rankin Scale score of >2).

They found: "Of the 214 patients who were studied (mean age, 74 years, with 50% of patients being men), 21 had a first-detected episode of AF, and 55 had chronic AF. The incidence of symptomatic intracranial hemorrhage was significantly higher in patients with chronic AF than in patients without AF (16% vs 5%), and the incidence of poor functional recovery was significantly higher in patients with chronic AF than in patients without AF (62% vs 44%). The increase in risk of symptomatic intracranial hemorrhage (but not in poor functional recovery) among patients with chronic AF remained significant after adjusting for age and baseline National Institutes of Health Stroke Scale score (odds ratio, 2.95). Patients with chronic AF who developed a symptomatic intracranial hemorrhage had a longer duration of AF than those who did not (59 vs 23 months), and patients with chronic AF who had a poor functional recovery had a longer duration of AF than those who did not (36 vs 16 months). By contrast, there were no differences in outcomes between patients with a first-detected episode of AF and those without AF, and between patients with paroxysmal AF and those with persistent or permanent AF."

The authors concluded: "Patients with chronic AF have worse stroke outcomes than do patients without AF, and the risk for worse outcomes was greater in patients with a longer duration of AF."

This begs the question of whether patients with atrial fibrillation would be better off without iv thrombolysis for ischemic stroke.

For the full abstract, click here.

Arch Neurol 68(11):1454-1458, November 2011 © 2011 to the American Medical Association
Relationship Between Chronic Atrial Fibrillation and Worse Outcomes in Stroke Patients After Intravenous Thrombolysis. Raymond C. S. Seet, Yi Zhang, Eelco F. Wijdicks, Alejandro A. Rabinstein. Correspondence to Dr. Seet: raymond_seet@nus.edu.sg

Category: N. Neurological, K. Circulatory. Keywords: stroke, hemorrhagic stroke, atrial fibrillation, thrombolysis, outcomes, functional recovery, retrospective cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 29 November 2011

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

COVID-19 Resources

WONCA webinars, journal links and more

WONCA position statements

WONCA statements on a variety of issues

PEARLS

577 Individual behavioural counselling helps people to quit smoking 575 Antioxidant vitamin and mineral supplements may be beneficial in age-related macular degeneration 574 Oral antifungals effective for toenail onychomycosis 570 Decision aids beneficial for people facing health treatment or screening decisions 569 Computer-generated reminders on paper benefit quality of care