Effect of Atrial Fibrillation on Prognosis of Stroke Patients Receiving Thrombolysis: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 GUOJiang , CHENNing , GUOJian , ZHOUMu-ke ,  HELi

Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

HELi, Email: heli2003new@126.com

Keywords：

Atrial fibrillation; Thrombolysis; Stroke; Meta-analysis; Cohort study

DOI：

10.7507/1672-2531.20150054

Video：

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Objective To evaluate whether atrial fibrillation could predict poor outcomes in stroke patients receiving thrombolysis by meta-analysis. Methods We searched MEDLINE, the Cochrane Library and EMbase databases for cohort studies concerning the effect of atrial ribrillation on prognosis of stroke patients receiving thrombolysis up to March 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of nine retrospective cohort studies involving 6 313 patients were included. The results of meta-analysis showed that:atrial fibrillation could increase the risk of symptomatic intracerebral hemorrhage (OR=1.51, 95%CI 1.15 to 1.99, P=0.003) and mortality (OR=1.90, 95%CI 1.29 to 2.80, P=0.001) of ischemic stroke patients receiving thrombolysis; the early improvement rate (OR=0.74, 95%CI 0.60 to 0.90, P=0.002) and later improvement rate (OR=0.50, 95%CI 0.39 to 0.64, P<0.000 01) of the atrial fibrillation group were lower than that of the non-atrial fibrillation group. Conclusion Atrial fibrillation could be a risk factor of poor outcome in ischemic stroke patients receiving thrombolysis. Due to the limitation of quantity and quality of the included studies, large-scale, multi-central and high quality clinical studies are needed.

Citation： GUOJiang, CHENNing, GUOJian, ZHOUMu-ke, HELi. Effect of Atrial Fibrillation on Prognosis of Stroke Patients Receiving Thrombolysis: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(3): 320-326. doi: 10.7507/1672-2531.20150054 Copy

1.	Tissue Plasminogen Activator for Acute Ischemic Stroke. The national institute of neurological disorders and stroke rt-PA stroke study group. N Engl J Med, 1995, 333(24):1581-1587.
2.	Awadh M, Macdougall N, Santosh C, et al. Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke:incidence and association with atrial fibrillation. Stroke, 2010, 41(9):1990-1995.
3.	Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment:pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet, 2004, 363(9411):768-774.
4.	Mazya M, Egido JA, Ford GA, et al. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase:safe implementation of treatments in stroke (SITS) symptomatic intracerebral hemorrhage risk score. Stroke, 2012, 43(6):1524-1531.
5.	Saposnik G, Guzik A K, Reeves M, et al. Stroke Prognostication using age and nih stroke scale:SPAN-100. Neurology, 2013, 80(1):21-28.
6.	Lin S, Wu B, Hao ZL, et al. Characteristics, treatment and outcome of ischemic stroke with atrial fibrillation in a chinese hospital-based stroke study. Cerebrovasc Dis, 2011, 31(5):419-426.
7.	Gattellari M, Goumas C, Aitken R, et al. Outcomes for patients with ischaemic stroke and atrial fibrillation:The PRISM Study (A Program of Research Informing Stroke Management). Cerebrovasc Dis, 2011, 32(4):370-382.
8.	Chao AC, Hsu HY, Chung CP, et al. Outcomes of thrombolytic therapy for acute ischemic stroke in Chinese patients:The Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study. Stroke, 2010, 41(5):885-890.
9.	Jauch EC, Saver JL, Adams HJ, et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the american heart association/american stroke association. Stroke, 2013, 44(3):870-947.
10.	Marini C, de Santis F, Sacco S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke:results from a population-based study. Stroke, 2005, 36(6):1115-1119.
11.	Liao J, Khalid Z, Scallan C, et al. Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke:a systematic review. Stroke, 2007, 38(11):2935-2940.
12.	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.
13.	Awadh M, Macdougall N, Santosh C, et al. Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke:incidence and association with atrial fibrillation. Stroke, 2010, 41(9):1990-1995.
14.	Sanak D, Herzig R, Kral M, et al. Is atrial fibrillation associated with poor outcome after thrombolysis? J Neurol, 2010, 257(6):999-1003.
15.	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.
16.	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.
17.	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.
18.	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.
19.	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.
20.	Padjen V, Bodenant M, Jovanovic DR, et al. Outcome of patients with atrial fibrillation after intravenous thrombolysis for cerebral ischaemia. J Neurol, 2013, 260(12):3049-3054.
21.	Westendorp WF, Nederkoorn PJ, Vermeij JD, et al. Post-stroke infection:a systematic review and meta-analysis. BMC Neurol, 2011, 11:110.
22.	Vermeij FH, Scholte ORW, de Man P, et al. Stroke-associated infection is an independent risk factor for poor outcome after acute ischemic stroke:data from the netherlands stroke survey. Cerebrovasc Dis, 2009, 27(5):465-471.
23.	Hong KS, Kang DW, Koo JS, et al. Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke. Eur J Neurol, 2008, 15(12):1324-1331.
24.	Katzan IL, Cebul RD, Husak SH, et al. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology, 2003, 60(4):620-625.
25.	Maagh P, Butz T, Wickenbrock I, et al. New-onset versus chronic atrial fibrillation in acute myocardial infarction:differences in short-and long-term follow-up. Clin Res Cardiol, 2011, 100(2):167-175.
26.	Kim JJ, Fischbein NJ, Lu Y, et al. Regional angiographic grading system for collateral flow:correlation with cerebral infarction in patients with middle cerebral artery occlusion. Stroke, 2004, 35(6):1340-1344.
27.	Bang OY, Saver JL, Buck BH, et al. Impact of collateral flow on tissue fate in acute ischaemic stroke. J Neurol Neurosurg Psychiatry, 2008, 79(6):625-629.
28.	Saito T, Tamura K, Uchida D, et al. Histopathological evaluation of left atrial appendage thrombogenesis removed during surgery for atrial fibrillation. Am Heart J, 2007, 153(4):704-711.
29.	Christou I, Alexandrov AV, Burgin WS, et al. Timing of recanalization after tissue plasminogen activator therapy determined by transcranial doppler correlates with clinical recovery from ischemic stroke. Stroke, 2000, 31(8):1812-1816.
30.	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.
31.	Molina CA, Alexandrov AV, Demchuk AM, et al. Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator. Stroke, 2004, 35(1):151-156.
32.	Baizabal-Carvallo JF, Rosso C, Alonso-Juarez M, et al. The hemodynamic status within 24 h after intravenous thrombolysis predicts infarct growth in acute ischemic stroke. J Neurol, 2012, 259(6):1045-1050.
33.	Neumann-Haefelin T, Hoelig S, Berkefeld J, et al. Leukoaraiosis is a risk factor for symptomatic intracerebral hemorrhage after thrombolysis for acute stroke. Stroke, 2006, 37(10):2463-2466.
34.	Miedema I, Luijckx GJ, de Keyser J, et al. Thrombolytic therapy for ischaemic stroke in patients using warfarin:a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry, 2012, 83(5):537-540.

1. Tissue Plasminogen Activator for Acute Ischemic Stroke. The national institute of neurological disorders and stroke rt-PA stroke study group. N Engl J Med, 1995, 333(24):1581-1587.
2. Awadh M, Macdougall N, Santosh C, et al. Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke:incidence and association with atrial fibrillation. Stroke, 2010, 41(9):1990-1995.
3. Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment:pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet, 2004, 363(9411):768-774.
4. Mazya M, Egido JA, Ford GA, et al. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase:safe implementation of treatments in stroke (SITS) symptomatic intracerebral hemorrhage risk score. Stroke, 2012, 43(6):1524-1531.
5. Saposnik G, Guzik A K, Reeves M, et al. Stroke Prognostication using age and nih stroke scale:SPAN-100. Neurology, 2013, 80(1):21-28.
6. Lin S, Wu B, Hao ZL, et al. Characteristics, treatment and outcome of ischemic stroke with atrial fibrillation in a chinese hospital-based stroke study. Cerebrovasc Dis, 2011, 31(5):419-426.
7. Gattellari M, Goumas C, Aitken R, et al. Outcomes for patients with ischaemic stroke and atrial fibrillation:The PRISM Study (A Program of Research Informing Stroke Management). Cerebrovasc Dis, 2011, 32(4):370-382.
8. Chao AC, Hsu HY, Chung CP, et al. Outcomes of thrombolytic therapy for acute ischemic stroke in Chinese patients:The Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study. Stroke, 2010, 41(5):885-890.
9. Jauch EC, Saver JL, Adams HJ, et al. Guidelines for the early management of patients with acute ischemic stroke:a guideline for healthcare professionals from the american heart association/american stroke association. Stroke, 2013, 44(3):870-947.
10. Marini C, de Santis F, Sacco S, et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke:results from a population-based study. Stroke, 2005, 36(6):1115-1119.
11. Liao J, Khalid Z, Scallan C, et al. Noninvasive cardiac monitoring for detecting paroxysmal atrial fibrillation or flutter after acute ischemic stroke:a systematic review. Stroke, 2007, 38(11):2935-2940.
12. 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.
13. Awadh M, Macdougall N, Santosh C, et al. Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke:incidence and association with atrial fibrillation. Stroke, 2010, 41(9):1990-1995.
14. Sanak D, Herzig R, Kral M, et al. Is atrial fibrillation associated with poor outcome after thrombolysis? J Neurol, 2010, 257(6):999-1003.
15. 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.
16. 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.
17. 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.
18. 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.
19. 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.
20. Padjen V, Bodenant M, Jovanovic DR, et al. Outcome of patients with atrial fibrillation after intravenous thrombolysis for cerebral ischaemia. J Neurol, 2013, 260(12):3049-3054.
21. Westendorp WF, Nederkoorn PJ, Vermeij JD, et al. Post-stroke infection:a systematic review and meta-analysis. BMC Neurol, 2011, 11:110.
22. Vermeij FH, Scholte ORW, de Man P, et al. Stroke-associated infection is an independent risk factor for poor outcome after acute ischemic stroke:data from the netherlands stroke survey. Cerebrovasc Dis, 2009, 27(5):465-471.
23. Hong KS, Kang DW, Koo JS, et al. Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke. Eur J Neurol, 2008, 15(12):1324-1331.
24. Katzan IL, Cebul RD, Husak SH, et al. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology, 2003, 60(4):620-625.
25. Maagh P, Butz T, Wickenbrock I, et al. New-onset versus chronic atrial fibrillation in acute myocardial infarction:differences in short-and long-term follow-up. Clin Res Cardiol, 2011, 100(2):167-175.
26. Kim JJ, Fischbein NJ, Lu Y, et al. Regional angiographic grading system for collateral flow:correlation with cerebral infarction in patients with middle cerebral artery occlusion. Stroke, 2004, 35(6):1340-1344.
27. Bang OY, Saver JL, Buck BH, et al. Impact of collateral flow on tissue fate in acute ischaemic stroke. J Neurol Neurosurg Psychiatry, 2008, 79(6):625-629.
28. Saito T, Tamura K, Uchida D, et al. Histopathological evaluation of left atrial appendage thrombogenesis removed during surgery for atrial fibrillation. Am Heart J, 2007, 153(4):704-711.
29. Christou I, Alexandrov AV, Burgin WS, et al. Timing of recanalization after tissue plasminogen activator therapy determined by transcranial doppler correlates with clinical recovery from ischemic stroke. Stroke, 2000, 31(8):1812-1816.
30. 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.
31. Molina CA, Alexandrov AV, Demchuk AM, et al. Improving the predictive accuracy of recanalization on stroke outcome in patients treated with tissue plasminogen activator. Stroke, 2004, 35(1):151-156.
32. Baizabal-Carvallo JF, Rosso C, Alonso-Juarez M, et al. The hemodynamic status within 24 h after intravenous thrombolysis predicts infarct growth in acute ischemic stroke. J Neurol, 2012, 259(6):1045-1050.
33. Neumann-Haefelin T, Hoelig S, Berkefeld J, et al. Leukoaraiosis is a risk factor for symptomatic intracerebral hemorrhage after thrombolysis for acute stroke. Stroke, 2006, 37(10):2463-2466.
34. Miedema I, Luijckx GJ, de Keyser J, et al. Thrombolytic therapy for ischaemic stroke in patients using warfarin:a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry, 2012, 83(5):537-540.

Chinese Journal of Evidence-Based Medicine

Effect of Atrial Fibrillation on Prognosis of Stroke Patients Receiving Thrombolysis: A Meta-analysis

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