What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke (n=20697). Intervention: Atrial fibrillation vs. No atrial fibrillation. Primary outcome: Remote intracerebral hemorrhage (rICH) (OR 1.821, 95% CI 1.082-3.065, p=<0.05).

November 30, 2023Open Access

Association of Atrial Fibrillation with Remote Intracerebral Hemorrhage After Intravenous Thrombolysis: Results from a Multicenter Study in China

Q: What are the key findings of this study?

Atrial fibrillation was independently associated with an increased risk of remote intracerebral hemorrhage (OR 1.821) in patients with acute ischemic stroke treated with intravenous thrombolysis.

Q: What does this research mean for the field?

Atrial fibrillation, particularly newly diagnosed atrial fibrillation, is independently associated with an increased risk of remote intracerebral hemorrhage following intravenous thrombolysis in patients with ischemic stroke. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Atrial fibrillation was independently associated with an increased risk of remote intracerebral hemorrhage (OR 1.821) in patients with acute ischemic stroke treated with intravenous thrombolysis.

Study Design

Type

Observational (n=20,697)

Multicenter

Yes

Structured PICO

Does atrial fibrillation increase the risk of remote intracerebral hemorrhage in patients with ischemic stroke treated with intravenous thrombolysis?

Population

20,697 patients with ischemic stroke who received intravenous thrombolysis (IVT) with recombinant tissue-type plasminogen activator, from a multicenter prospective registry of a Chinese population.

Intervention

Atrial fibrillation (total, previously known, and newly diagnosed)

Comparator

No atrial fibrillation

Outcome

Remote intracerebral hemorrhage (rICH), defined as any extraischemic hemorrhage detected on computerized tomography (CT) 24 h after intravenous thrombolysissafety

Atrial fibrillation, particularly newly diagnosed AF, is independently associated with an increased risk of remote intracerebral hemorrhage following intravenous thrombolysis for ischemic stroke.

Main Result

Effect estimate: OR 1.821 (95% CI 1.082-3.065)

p-value: p=<0.05

Limitations

Retrospective case-control study design, despite prospective data collection
Did not include imaging features before and after thrombolysis, such as high-density shadow of the middle cerebral artery, previously damaged lesions, cerebral microbleeds, and white matter lesions

Abstract

INTRODUCTION: This study aimed to investigate the association between atrial fibrillation (AF), particularly newly diagnosed AF, and remote intracerebral hemorrhage (rICH) in patients with ischemic stroke who were treated with intravenous thrombolysis (IVT). METHODS: This observational study was conducted on patients with ischemic stroke who received IVT with recombinant tissue-type plasminogen activator. The data were taken from a multicenter prospective registry of a Chinese population. rICH was defined as any extraischemic hemorrhage detected on computerized tomography (CT) 24 h after intravenous thrombolysis. We collected and compared the demographic data and clinical characteristics of all the patients with rICH to those of patients without any type of hemorrhagic transformation. The association between AF and rICH was analyzed using univariate analysis and binary logistic regression. RESULTS: A total of 20,697 patients were included in the study, with 1566 (7.6%) experiencing intracerebral hemorrhage (ICH), 586 (2.8%) experiencing rICH, and 19,131 (92.4%) not experiencing any form of hemorrhagic transformation. Univariate analysis revealed significant differences in age, pre-thrombolysis systolic blood pressure, baseline National Institute of Health Stroke Scale score, previously 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 indicated that total AF (OR 1.821, 95% CI 1.082-3.065, P < 0.05), previously 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 independently associated with rICH. CONCLUSIONS: This study suggests that AF, regardless of whether it is newly diagnosed or previously known, may be associated with the occurrence of rICH following intravenous thrombolysis. Interestingly, our findings suggest that newly diagnosed AF may have a stronger impact on rICH than previously known AF, although confirmation from more studies is needed.

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