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Abstract Details

Does atrial fibrillation increase the risk of hemorrhagic transformation in acute stroke patients following thrombolytic therapy?
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
066

Atrial fibrillation (AF) is a risk factor for poor outcomes and it has been implicated to increase the risk for hemorrhagic transformation following treatment with intravenous tissue plasminogen activator (tPA). With tight blood pressure control post tPA implemented at our center as standard of care, we thought to re-examine this correlation.

 
Studies have showed that patients with history of AF are associated with a higher degree of disability, increased ICH and worse outcomes compared to patients with no AF. Old age could have been a confounding fcator in some studies.
A retrospective analysis of all tPA treated patients at a mid-South Comprehensive Stroke Center (2014 to 2019) were included in our study. Standard of care assessments of discharge and 90 days outcomes, risk for symptomatic intracerebral hemorrhage (sICH), and in hospital mortality between AF patients and non-AF patients were studied. A multivariate analysis was performed using logistic regression model.
A total of 1341 patients received tPA (mean age 63.8 SD± 31, 48.6% women, 62.5% African American, admission NIH stroke scale median 7, 3 – 13 IQR). Of these, 153 (11.4%) had AF. In a multivariate analysis after adjusting for confounders, AF patients were associated with significantly higher risk for sICH (OR 2.491, 95% CI 1.277-4.859, p=0.007) and increased risk for all ICH (symptomatic and asymptomatic) (OR 2.608, 95% CI 1.299-5.235, p=0.007). When compared to non-AF patients, AF patients had worse clinical outcomes with mRS 0-2 at 3 months (OR 0.323, CI 0.179-0.582, p<0.001) and were associated with increased in hospital mortality (OR 3.709, CI 2.308-5.959, p<0.001).
AF remains a challenging risk factor that increases the risk of sICH and poor outcomes in mainly African American stroke patients in mid-South. Strategies to improve recanalization rates and BP control in this vulnerable population should be the focus of future studies.
Authors/Disclosures
Prasanna Venkatesan Eswaradass, MD (University of Kansas Health System)
PRESENTER 		Dr. Eswaradass has nothing to disclose.
Reza Bavarsad Shahripour, MD (University of California, San Diego (UCSD)) Dr. Bavarsad Shahripour has nothing to disclose.
Omar Saeed, MD Dr. Saeed has nothing to disclose.
Savdeep Singh, MD (Savdeep Singh) Dr. Singh has nothing to disclose.
Mark N. Rubin, MD (Edward Hines, Jr. VAMC) Dr. Rubin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovaSignal. Dr. Rubin has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for INSPE.
Katherine Nearing, MD (UTHSC, Department of Neurology) Dr. Nearing has nothing to disclose.
Anne Alexandrov Anne Alexandrov has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. The institution of Anne Alexandrov has received research support from National Institutes of Health.
Balaji Krishnaiah, MD, FÂ鶹´«Ã½Ó³»­ (University of Tennessee Health Sciences Center) Dr. Krishnaiah has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for ACP. Dr. Krishnaiah has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Merck Manual. Dr. Krishnaiah has received publishing royalties from a publication relating to health care.
Andrei V. Alexandrov, MD (Department of Neurology, UTHSC) The institution of Dr. Alexandrov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovaSignal. Dr. Alexandrov has received personal compensation in the range of $500-$4,999 for serving as a Consultant for NovoNordisc. Dr. Alexandrov has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca. Dr. Alexandrov has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for American Society of Neuroimaging. Dr. Alexandrov has received publishing royalties from a publication relating to health care.