Correlation between Atrial Fibrillation and Prognosis of Patients with Ischemic Stroke after Intravenous Thrombolysis: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHOUJia-jun ,  SHAOSen

Department of Neurology, Xixi Hospital of Hangzhou, Zhejiang University of Traditional Chinese Medicine, Hangzhou 310023, China;

Corresponding author：

SHAOSen, Email: hot005194@Gmail.com

Keywords：

Atrial fibrillation; Ischemic stroke; Thrombolytic therapy; Hemorrhage; Systematic review; Meta-analysis; Cohort study

DOI：

10.7507/1672-2531.20140220

Video：

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Objective To systematically review the correlation between atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. Methods Literature search was carried out in PubMed, EMbase, Web of Science, The Cochrane Library (Issue 4, 2014), CBM and WanFang Data up to April 2014 for the domestic and foreign cohort studies on atrial fibrillation and prognosis of patients with ischemic stroke after intravenous thrombolysis. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2. Results A total of 7 cohort studies were finally included involving 69 017 cases. The results of meta-analysis showed that, compared with patients without atrial fibrillation, atrial fibrillation reduced 3-month favourable nerve function of patients with atrial fibrillation (OR=0.85, 95%CI 0.73 to 0.98, P=0.03) but did not influence the risk of death after intravenous thrombolysis (OR=1.47, 95%CI 0.75 to 2.86, P=0.26); and increased the risks of intracranial haemorrhagic transformation (OR=1.36, 95%CI 1.26 to 1.47, P < 0.001) and symptomatic intracranial hemorrhage after intravenous thrombolysis (OR=1.43, 95%CI 1.02 to 1.99, P=0.04). Conclusion For patients with ischemic stroke, atrial fibrillation does not influence the risk of death, but it increases the risks of intracranial hemorrhage, and worsens 3-month favourable nerve function of after intravenous thrombolysis. For those patients, more assessment before intravenous thrombolysis and more monitoring after intravenous thrombolysis are necessary. Due to limited quality and quantity of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality studies.

Citation： ZHOUJia-jun, SHAOSen. Correlation between Atrial Fibrillation and Prognosis of Patients with Ischemic Stroke after Intravenous Thrombolysis: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2014, 14(11): 1367-1372. doi: 10.7507/1672-2531.20140220 Copy

1.	Lloyd-jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation:the Framingham Heart Study. Circulation, 2004, 110(9):1042-1046.
2.	Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke:the Framingham Study. Stroke, 1991, 22(8):983-988.
3.	Candelise L, Pinardi G, Morabito A. Mortality in acute stroke with atrial fibrillation. The Italian Acute Stroke Study Group. Stroke, 1991, 22(2):169-174.
4.	Kimura K, Minematsu K, Yamaguchi T, et al. Atrial fibrillation as a predictive factor for severe stroke and early death in 15831 patients with acute ischemic stroke. J Neurol Neurosurg Psychiatry, 2005, 76(5):679-683.
5.	Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke:an updated systematic review and meta-analysis. Lancet, 2012, 379(9834):2364-2372.
6.	Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med, 2008, 359(13):1317-1329.
7.	重组组织型纤溶酶原激活剂治疗缺血性卒中共识专家组.重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中中国专家共识(2012版).中华内科杂志, 2012, 51(12):1006-1010.
8.	Kimura K, Iguchi Y, Shibazaki K, et al. IV t-PA therapy in acute stroke patients with atrial fibrillation. J Neurol Sci, 2009, 276(1-2):6-8.
9.	Zhang JB, Ding ZY, Yang Y, et al. Thrombolysis with alteplase for acute ischemic stroke patients with atrial fibrillation. Neurol Res, 2010, 32(4):353-358.
10.	Sung SF, Chen YW, Tseng MC, et al. Atrial fibrillation predicts good functional outcome following intravenous tissue plasminogen activator in patients with severe stroke. Clin Neurol Neurosurg, 2013, 115(7):892-895.
11.	Larrue V, von Kummer RR, Müller A, et al. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator:a secondary analysis of the European-Australasian Acute Stroke Study (ECASS Ⅱ). Stroke, 2001, 32(2):438-441.
12.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9):603-605.
13.	王贞, 张万里, 冯靓, 等.心房颤动与缺血性卒中静脉溶栓预后的相关性.中华神经科杂志, 2013, 46(11):725-729.
14.	Saposnik G, Gladstone D, Raptis R, et al. Atrial fibrillation in ischemic stroke:predicting response to thrombolysis and clinical outcomes. Stroke, 2013, 44(1):99-104.
15.	Frank B, Fulton R, Weimar C, et al. Impact of atrial fibrillation on outcome in thrombolyzed patients with stroke:evidence from the Virtual International Stroke Trials Archive (VISTA). Stroke, 2012, 43(7):1872-1877.
16.	Nasr DM, Brinjikji W, Cloft HJ, et al. Utilization of intravenous thrombolysis is increasing in the United States. Int J Stroke, 2013, 8(8):681-688.
17.	尤寿江, 曹勇军, 肖国栋, 等.伴有心房颤动的急性缺血性卒中患者重组组织型纤溶酶原激活剂静脉溶栓的疗效及预后.中华神经科杂志, 2013, 46(10):681-686.
18.	Seet RC, Zhang Y, Wijdicks EF, et al. Relationship between chronic atrial fibrillation and worse outcomes in stroke patients after intravenous thrombolysis. Arch Neurol, 2011, 68(11):1454-1458.
19.	娄一萍, 严慎强, 张圣, 等.合并心房颤动对急性缺血性卒中患者静脉溶栓治疗后临床结局的影响.浙江大学学报(医学版), 2014, 43(1):28-35.
20.	Lees KR, Bluhmki E, von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke:an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet, 2010, 375(9727):1695-1703.
21.	Kimura K, Iguchi Y, Yamashita S, et al. Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke. J Neurol Sci, 2008, 267(1-2):57-61.
22.	Heinsius T, Bogousslavsky J, van Melle G. Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns. Neurology, 1998, 50(2):341-350.
23.	McGrath ER, Kapral MK, Fang J, et al. Association of atrial fibrillation with mortality and disability after ischemic stroke. Neurology, 2013, 81(9):825-832.
24.	Whiteley WN, Slot KB, Fernandes P, et al. Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator:a systematic review and meta-analysis of 55 studies. Stroke, 2012, 43(11):2904-2909.
25.	Naess H, Waje-Andreassen U, Thomassen L, et al. Persistent atrial fibrillation is associated with worse prognosis than paroxysmal atrial fibrillation in acute cerebral infarction. ISRN Cardiol, 2012, 2012:650915.
26.	Cappellari M, Bovi P, Micheletti N, et al. The risk stratification based on the CHADS-VASc may predict the response to intravenous thrombolysis after stroke. J Neurol, 2013, 260(10):2681-2683.

1. Lloyd-jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation:the Framingham Heart Study. Circulation, 2004, 110(9):1042-1046.
2. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke:the Framingham Study. Stroke, 1991, 22(8):983-988.
3. Candelise L, Pinardi G, Morabito A. Mortality in acute stroke with atrial fibrillation. The Italian Acute Stroke Study Group. Stroke, 1991, 22(2):169-174.
4. Kimura K, Minematsu K, Yamaguchi T, et al. Atrial fibrillation as a predictive factor for severe stroke and early death in 15831 patients with acute ischemic stroke. J Neurol Neurosurg Psychiatry, 2005, 76(5):679-683.
5. Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke:an updated systematic review and meta-analysis. Lancet, 2012, 379(9834):2364-2372.
6. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med, 2008, 359(13):1317-1329.
7. 重组组织型纤溶酶原激活剂治疗缺血性卒中共识专家组.重组组织型纤溶酶原激活剂静脉溶栓治疗缺血性卒中中国专家共识(2012版).中华内科杂志, 2012, 51(12):1006-1010.
8. Kimura K, Iguchi Y, Shibazaki K, et al. IV t-PA therapy in acute stroke patients with atrial fibrillation. J Neurol Sci, 2009, 276(1-2):6-8.
9. Zhang JB, Ding ZY, Yang Y, et al. Thrombolysis with alteplase for acute ischemic stroke patients with atrial fibrillation. Neurol Res, 2010, 32(4):353-358.
10. Sung SF, Chen YW, Tseng MC, et al. Atrial fibrillation predicts good functional outcome following intravenous tissue plasminogen activator in patients with severe stroke. Clin Neurol Neurosurg, 2013, 115(7):892-895.
11. Larrue V, von Kummer RR, Müller A, et al. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator:a secondary analysis of the European-Australasian Acute Stroke Study (ECASS Ⅱ). Stroke, 2001, 32(2):438-441.
12. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9):603-605.
13. 王贞, 张万里, 冯靓, 等.心房颤动与缺血性卒中静脉溶栓预后的相关性.中华神经科杂志, 2013, 46(11):725-729.
14. Saposnik G, Gladstone D, Raptis R, et al. Atrial fibrillation in ischemic stroke:predicting response to thrombolysis and clinical outcomes. Stroke, 2013, 44(1):99-104.
15. Frank B, Fulton R, Weimar C, et al. Impact of atrial fibrillation on outcome in thrombolyzed patients with stroke:evidence from the Virtual International Stroke Trials Archive (VISTA). Stroke, 2012, 43(7):1872-1877.
16. Nasr DM, Brinjikji W, Cloft HJ, et al. Utilization of intravenous thrombolysis is increasing in the United States. Int J Stroke, 2013, 8(8):681-688.
17. 尤寿江, 曹勇军, 肖国栋, 等.伴有心房颤动的急性缺血性卒中患者重组组织型纤溶酶原激活剂静脉溶栓的疗效及预后.中华神经科杂志, 2013, 46(10):681-686.
18. Seet RC, Zhang Y, Wijdicks EF, et al. Relationship between chronic atrial fibrillation and worse outcomes in stroke patients after intravenous thrombolysis. Arch Neurol, 2011, 68(11):1454-1458.
19. 娄一萍, 严慎强, 张圣, 等.合并心房颤动对急性缺血性卒中患者静脉溶栓治疗后临床结局的影响.浙江大学学报(医学版), 2014, 43(1):28-35.
20. Lees KR, Bluhmki E, von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke:an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet, 2010, 375(9727):1695-1703.
21. Kimura K, Iguchi Y, Yamashita S, et al. Atrial fibrillation as an independent predictor for no early recanalization after IV-t-PA in acute ischemic stroke. J Neurol Sci, 2008, 267(1-2):57-61.
22. Heinsius T, Bogousslavsky J, van Melle G. Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns. Neurology, 1998, 50(2):341-350.
23. McGrath ER, Kapral MK, Fang J, et al. Association of atrial fibrillation with mortality and disability after ischemic stroke. Neurology, 2013, 81(9):825-832.
24. Whiteley WN, Slot KB, Fernandes P, et al. Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator:a systematic review and meta-analysis of 55 studies. Stroke, 2012, 43(11):2904-2909.
25. Naess H, Waje-Andreassen U, Thomassen L, et al. Persistent atrial fibrillation is associated with worse prognosis than paroxysmal atrial fibrillation in acute cerebral infarction. ISRN Cardiol, 2012, 2012:650915.
26. Cappellari M, Bovi P, Micheletti N, et al. The risk stratification based on the CHADS-VASc may predict the response to intravenous thrombolysis after stroke. J Neurol, 2013, 260(10):2681-2683.

Chinese Journal of Evidence-Based Medicine

Correlation between Atrial Fibrillation and Prognosis of Patients with Ischemic Stroke after Intravenous Thrombolysis: A Meta-Analysis

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