Department of Neurology, Affiliated Drum Tower Hospital of
1Nanjing University Medical School, Nanjing 210008, China
2Department of Rehabilitation Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
3Jiangsu Stroke Research Collaborative Group, Nanjing 210008, China
4Jiangsu Province Stroke Center for Diagnosis and Therapy, Nanjing 210008, China
5Department of Neurology, Northern Jiangsu People’s Hospital, Yangzhou 225001, China
6Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
7Department of Neurology, Affiliated BenQ Hospital of Nanjing Medical University, Nanjing 210019, China
8Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
9Department of Neurology, The Affiliated Huaian First People’s Hospital of Nanjing Medical University, Huaian 223300, China
10Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
11Department of Neurology, Affiliated Xuzhou Central Hospital of Xuzhou Medical College, Xuzhou 221009, China
12Department of Neurology, Affiliated Hospital of Jiangsu University, Zhenjiang 212002, China
13Department of Neurology, Jiangyin People’s Hospital, Jiangyin 214400, China
14Department of Neurology, The Second Affiliated Hospital of Xuzhou Medical College, Xuzhou 221006, China
15Department of Neurology, The First People’s Hospital of Lianyungang, Lianyungang 222002, China
16Department of Neurology, The First Affiliated Hospital of Xuzhou Medical College, Xuzhou 221000, China
17Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
18Department of Neurology, Gaochun People’s Hospital, Nanjing 211300, China
19Department of Neurology, Drum Tower Hospital of Nanjing Medical University, Nanjing 210008, China
20Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, Nanjing 210008, China

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.

Keywords

Ischemic stroke; Atrial fibrillation; Intravenous recombinant tissue plasminogen activator; Intravenous thrombolysis; Favorable outcome; Risk factors Int

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