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Influences of Intravenous Thrombolysis with Recombinant Tissue-type Plasminogen Activator on the Outcome of Atrial Fibrillation Patients with Acute Ischemic Stroke: A Case a Case-control Study of 227 Patients


 Background: It is a debatable topic about the benefit of intravenous (IV) thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) for atrial fibrillation (AF) patients with acute ischemic stroke (AIS). This study aimed to identify whether IV rt-PA could improve the short-term outcome of patients with AF-AIS.Methods: Medical data of patients with AIS onset within 72hs admitted in the department of neurologic of our hospital between January 1st, 2015 and December 31, 2020 were extracted. The AF-AIS patients were selected and divided into IV rt-PA group (group A) and non-rt-PA group (group B). The baseline characteristics, imaging changes and modified Rankin Scale (mRS) score (≤ 2 as good prognosis, > 2 as poor, = 6 as death) at discharge were obtained to compare the differences between the two groups. Logistic regression was used to analyze the factors influencing on the outcome. Results: Among a total of 1663 AIS patients, there were 280 had AF, of them 227 AF-AIS cases were conformed to the inclusion criteria, including 45 in group A and 182 in group B. All of AF-AIS patients, 48.0% had larger size of infarction and 62.1% had National Institute of Health stroke scale (NIHSS)score more than 10, the differences in the size and NIHSS between the two groups were not significant. A total of 51 cases (22.5%) died during hospitalization, the difference between group A and group B was not obvious (20.0% vs. 23.1%, P=0.658). The cumulative poor outcome (including deaths) at discharge was 75.3%, the difference between the two groups was also not significant (77.8% vs. 74.7%, P=0.671). The incidence of hemorrhagic transformation (HT) in group A was higher than that of in group B (40.0% vs. 21.4, P=0.010), the same was true for parenchymal hematoma (PH) in group A than group B (22.2% vs. 5.5%, P = 0.001). On univariate analysis, poor outcome was significantly associated with infarct size, NIHSS and PH, but not thrombolysis. The proportion of PH in patients with poor outcome between the two groups was also not remarkable. On adjusted multiple logistic regression analysis, both baseline infarction size [(P=0.013, odds ratio (OR) =4.558, 95% 95% confidence interval (CI): 1.373- 15.133] and NIHSS (P<0.001, OR=1.348, 95% CI=1.219-1.491) but not thrombolysis or PH entered into the final model as significant independent risk factors of poor outcome. Conclusion: Patients with AF-AIS had larger infarction size, higher NIHSS score, higher rate of mortality and worse outcome, for them, the IV rt-PA increased the incidence of PH except significantly improved their short-term prognosis.