Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Research Division of Clinical Pharmacology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
BMC Neurol. 2021 Feb 11;21(1):66. doi: 10.1186/s12883-021-02095-x.
The efficacy and safety of intravenous thrombolysis (IVT) for acute ischemic stroke with atrial fibrillation (AF) is still controversial.
We conducted a meta-analysis of all relevant studies, retrieved through systematic search of PubMed, Embase, and Cochrane databases up to December 31, 2019. Modified Rankin Scale (mRS) scores of 0-1 at 90 days, mRS of 0-2 at 90 days, overall mortality, and incidence of symptomatic intracranial hemorrhage (sICH) were collected as outcome measures. Fixed- and random-effects meta-analytical models were applied, and between-study heterogeneity was assessed.
A total of 8509 patients were enrolled in 18 studies. A comparison of IVT treatment in AF versus non-AF patients showed that AF was associated with a significantly lower proportion of patients with mRS of 0-1 (24.1% vs. 34.5%; OR 0.59; 95% CI 0.43-0.81; P < 0.001), mRS of 0-2 (33.6% vs. 47.8%; OR 0.55; 95% CI 0.43-0.70; P < 0.001), as well as significantly higher mortality (19.4% vs. 11.5%; OR 2.05; 95% CI 1.79-2.36; P < 0.001) and higher incidence of sICH (6.4% vs. 4.1%; OR 1.60; 95% CI 1.27-2.01; P < 0.001). A comparison of AF patients who were subjected or not to IVT showed that thrombolysis carried a higher risk of sICH (5.7% vs. 1.6%; OR 3.44; 95% CI 2.04-5.82; P < 0.001) and was not associated with a better prognosis. Subgroup analysis in prospective studies also suggested a poorer functional prognosis and higher mortality in AF patients treated with IVT compared with those who did not receive IVT. Some heterogeneity was present in this meta-analysis.
Acute IS patients with AF had worse outcomes than those without AF after thrombolytic therapy, and had a higher incidence of sICH after thrombolysis than those without thrombolysis. Thrombolysis in ischemic stroke patients with AF should be carefully considered based on clinical factors such as NIHSS score, age, and the type of AF.
对于伴有心房颤动（AF）的急性缺血性脑卒中患者，静脉溶栓（IVT）的疗效和安全性仍存在争议。
我们对截至 2019 年 12 月 31 日通过系统检索 PubMed、Embase 和 Cochrane 数据库获得的所有相关研究进行了荟萃分析。90 天的改良 Rankin 量表（mRS）评分 0-1、90 天 mRS 评分 0-2、总死亡率和症状性颅内出血（sICH）发生率作为观察指标。采用固定效应和随机效应模型进行荟萃分析，并评估研究间的异质性。
共有 8509 例患者纳入 18 项研究。与非 AF 患者相比，IVT 治疗 AF 患者的结果显示，AF 患者 mRS 评分 0-1 的比例显著较低（24.1% vs. 34.5%；OR 0.59；95% CI 0.43-0.81；P<0.001）、mRS 评分 0-2 的比例显著较低（33.6% vs. 47.8%；OR 0.55；95% CI 0.43-0.70；P<0.001）、死亡率显著较高（19.4% vs. 11.5%；OR 2.05；95% CI 1.79-2.36；P<0.001）和 sICH 发生率显著较高（6.4% vs. 4.1%；OR 1.60；95% CI 1.27-2.01；P<0.001）。AF 患者接受或不接受 IVT 治疗的比较结果显示，溶栓治疗的 sICH 风险更高（5.7% vs. 1.6%；OR 3.44；95% CI 2.04-5.82；P<0.001），但预后无显著改善。前瞻性研究的亚组分析也提示，与未接受 IVT 治疗的患者相比，接受 IVT 治疗的 AF 患者的功能预后更差，死亡率更高。本荟萃分析存在一定的异质性。
与未接受溶栓治疗的 AF 患者相比，接受溶栓治疗的急性 IS 患者预后较差，溶栓后 sICH 发生率高于未溶栓患者。对于伴有 AF 的缺血性脑卒中患者，溶栓治疗应根据 NIHSS 评分、年龄和 AF 类型等临床因素进行慎重考虑。
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