Atrial fibrillation does not modify treatment effect of bridging thrombolysis, study finds

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Leonard Yeo

An international study conducted by Leonard Yeo (National University Hospital, Singapore) and colleagues has found that the presence of atrial fibrillation does not modify the treatment effect of bridging intravenous thrombolysis (IVT) in ischaemic stroke patients undergoing a thrombectomy procedure.

The results of this research are published in the Journal of NeuroInterventional Surgery (JNIS).

Yeo and colleagues initially note that the role of IVT prior to endovascular thrombectomy in acute ischaemic stroke patients remains a matter of debate, and that atrial fibrillation-associated strokes may be associated with a reduced treatment effect from IVT.

As such, they conducted a retrospective, multicentre, international cohort study to compare the effects of bridging IVT in atrial fibrillation versus non-atrial fibrillation patients. More specifically, the cohort included anterior circulation large vessel occlusion (LVO) acute ischaemic stroke patients receiving thrombectomy alone, or bridging IVT plus thrombectomy, within six hours of symptom onset.

According to Yeo and colleagues, the primary outcome for their study was a good functional outcome defined as modified Rankin Scale (mRS) score of 0–2 at 90 days. Secondary outcomes were successful reperfusion—defined as an expanded Thrombolysis In Cerebral Infarction (eTICI) grading of ≥2b flow—as well as symptomatic intracerebral haemorrhage (sICH) and in-hospital mortality.

A total of 705 patients (mean age 68.6 years, 53.9% male) were included in the analysis—314 of whom had atrial fibrillation present and 391 of whom did not.

The odds of a good functional outcome with bridging IVT were higher in the non-atrial fibrillation group (adjusted odds ratio [aOR] 2.28) compared with the atrial fibrillation subgroups (aOR 1.89), the authors detail.

“However, this did not constitute a significant effect modification by the presence of atrial fibrillation on bridging IVT,” Yeo and colleagues continue, noting an interaction aOR of 0.12. “The rate of successful reperfusion, sICH and mortality were similar between bridging IVT and EVT [endovascular therapy] for both atrial fibrillation and non-atrial fibrillation patients.”

Based on this finding, the authors conclude in their JNIS report that the presence of atrial fibrillation did not modify the treatment effect of bridging IVT. However, they add that further individual patient data meta-analyses of randomised trials “may shed light on the comparative efficacy of bridging IVT in atrial fibrillation versus non-atrial fibrillation LVO strokes”.


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