Bridging thrombolysis in atrial fibrillation stroke is associated with increased hemorrhagic complications without improved outcomes
Year: 2021
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Atrial fibrillation (AF) associated ischemic stroke is associated with worse functional outcomes, less effective recanalization, and increased rates of hemorrhagic complications after intravenous thrombolysis (IVT). Conversely, AF is not associated with hemorrhagic complications or functional outcomes in patients undergoing mechanical thrombectomy (MT). This differential effect of MT and IVT in AF associated stroke raises the question of whether bridging thrombolysis increases hemorrhagic complications in AF patients undergoing MT. METHODS: This international cohort study of 22 comprehensive stroke centers analyzed patients with large vessel occlusion (LVO) undergoing MT between June 1, 2015 and December 31, 2020. Patients were divided into four groups based on comorbid AF and IVT exposure. Baseline patient characteristics, complications, and outcomes were reported and compared. RESULTS: 6461 patients underwent MT for LVO. 2311 (35.8%) patients had comorbid AF. In non-AF patients, bridging therapy improved the odds of good 90 day functional outcomes (adjusted OR (aOR) 1.29, 95% CI 1.03 to 1.60, p=0.025) and did not increase hemorrhagic complications. In AF patients, bridging therapy led to significant increases in symptomatic intracranial hemorrhage and parenchymal hematoma type 2 (aOR 1.66, 1.07 to 2.57, p=0.024) without any benefit in 90 day functional outcomes. Similar findings were noted in a separate propensity score analysis. CONCLUSION: In this large thrombectomy registry, AF patients exposed to IVT before MT had increased hemorrhagic complications without improved functional outcomes, in contrast with non-AF patients. Prospective trials are warranted to assess whether AF patients represent a subgroup of LVO patients who may benefit from a direct to thrombectomy approach at thrombectomy capable centers.
Authors: Feras Akbik, Ali Alawieh, Laurie Dimisko, Brian M Howard, C Michael Cawley, Frank C Tong, Fadi Nahab, Owen B Samuels, Ilko Maier, Wuwei Feng, Nitin Goyal, Robert M Starke, Ansaar Rai, Kyle M Fargen, Marios N Psychogios, Pascal Jabbour, Reade De Leacy, Saleh G Keyrouz, Travis M Dumont, Peter Kan, Jan Liman, Adam S Arthur, Stacey Q Wolfe, J Mocco, Roberto Javier Crosa, W Christopher Fox, Benjamin Gory, Alejandro M Spiotta, Jonathan A Grossberg
Institutions: Emory University, Medical University of South Carolina, Universitätsmedizin Göttingen, University of Göttingen, Duke Medical Center, University of Tennessee Health Science Center, University of Miami, West Virginia University Hospitals, Wake Forest University, University Hospital of Basel, Thomas Jefferson University, Mount Sinai Health System, Washington University in St. Louis, Banner - University Medical Center Tucson, The University of Texas Medical Branch at Galveston, Mayo Clinic in Florida, Inserm, Centre Hospitalier Régional et Universitaire de Nancy, Imagerie Adaptative Diagnostique et Interventionnelle, Université de Lorraine
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3216191478