Predictors of Post-Alteplase Long-Term Unfavorable Outcome in Atrial Fibrillation Patients Presented with Embolic Stroke in the Middle East and North Africa Regions: A Multi-center, Longitudinal Study

Embolic stroke is connected to a higher risk of hemorrhagic transformation (HT), functional disability, and mortality. There is a gap of knowledge regarding the predictors of long-term post-alteplase functional outcomes, especially in patients with atrial fibrillation (AF), which limits delivering adequate care and support to stroke survivors. We aimed to assess the predictors of long-term post-thrombolysis unfavorable functional outcomes in patients with atrial fibrillation who presented with first-ever embolic stroke in the Middle East and North Africa (MENA). Our prospective cohort study was conducted between May 2021 and May 2025 and included patients with AF who presented with first-ever embolic stroke and received thrombolytic therapy, and who were recruited from Kafr Elsheikh University Hospital, Kafr Elsheikh General Hospital, Al-Sahel Teaching Hospital, NMC Royal Hospital, and Al-Obour Hospital in the period from May 2021 to May 2023. Our longitudinal study included two groups; the unfavorable outcomes group, and the favorable outcomes group. A total of 580 patients completed the 2-year follow-up period. National institute of health stroke scale (NIHSS) at the time of admission [odds ratio (OR), 2.06; 95% CI, 1.86–4.39; P = 0.03], sustained atrial fibrillation (OR, 1.98; 95% CI, 1.42–3.80; P = 0.03), heart failure (OR, 1.79; 95% CI, 1.23–2.96; P = 0.03), HAS-BLED score (OR, 1.64; 95% CI, 1.41–3.65; P = 0.03), CHA2DS2VASc score (OR, 1.72; 95% CI, 1.72–3.53; P = 0.04), post-thrombolysis intracranial hemorrhage (OR, 2.89; 95% CI, 1.74–3.63; P = 0.02), and recurrent symptomatic stroke (OR, 1.98; 95% CI, 1.22–3.73; P = 0.04) were predictors of long-term post-thrombolysis unfavorable outcomes. Higher baseline NIHSS, heart failure, post-thrombolysis intracranial haemorrhage, and recurrent symptomatic stroke were independent predictors of long-term post-thrombolysis unfavorable functional outcome in embolic stroke patients. Novelly, higher HAS-BLED and CHA2DS2-VASc scores were independent predictors of long-term post-thrombolysis unfavorable functional outcome in Arabian patients. Moreover, sustained AF was an independent predictor of long-term post-thrombolysis unfavorable functional outcome.