Association of newly diagnosed atrial fibrillation with remote intracerebral hemorrhage after intravenous thrombolysis: Results from a multicenter study in China

Objective To investigate the association of atrial fibrillation (AF), especially newly diagnosed AF, with remote intracerebral hemorrhage (rICH) in patients with ischemic stroke treated by intravenous thrombolysis. Methods This is an observational study of patients with ischemic stroke who were treated with intravenous thrombolysis with recombinant tissue-type plasminogen activator whose data were taken from a multicenter prospective registry of a Chinese population. RICH was defined as any extraischemic hemorrhage detected by imaging examination ≤ 24 hours after intravenous thrombolysis. We collected the demographic data and clinical characteristics of all the patients. We compared patients with rICH and those without any type of hemorrhagic transformation. The association of AF and rICH was analyzed by univariate analysis and binary logistic regression. Results We evaluated 20697 patients, 1566 (7.6%) of whom developed intracerebral hemorrhage (ICH), 586 (2.8%) of whom experienced rICH, and 19131 (92.4%) of whom did not experience any type of hemorrhagic transformation. Univariate analysis showed that there were significant differences in age, prethrombolysis systolic blood pressure, baseline NIHSS score, known AF, newly diagnosed AF, coronary heart disease, congestive heart failure, hyperhomocysteinemia and history of thrombolysis between the rICH and control groups (P < 0.05). Further multivariate logistic regression analysis showed that total AF [OR 1.821, (95%CI, 1.082-3.065), P < 0.05], known AF [OR 1.470, (95%CI, 1.170-1.847)] and newly diagnosed AF [OR 1.920, (95%CI, 1.304-2.825)] were all independently associated with rICH. Conclusions This study suggests that AF (regardless of the newly diagnosed or known AF) may be associated with the occurrence of rICH after intravenous thrombolysis. Interestingly, newly diagnosed AF may have a greater impact on rICH than known AF, but that finding needs to be confirmed by a larger prospective sample.