Efficacy and safety of thrombolysis for acute ischemic stroke with atrial fibrillation: a meta-analysis.
Efficacy and safety of thrombolysis for acute ischemic stroke with atrial fibrillation: a meta-analysis.
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溶栓治疗急性缺血性脑卒中合并心房颤动的有效性和安全性：荟萃分析
DOI：
10.1186/s12883-021-02095-x
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发表时间：
2021-02-11
期刊：
影响因子：
2.6
通讯作者：
Ji C
中科院分区：
文献类型：
--
作者：
Hu Y;Ji C
背景静脉溶栓（IVT）治疗急性缺血性卒中合并心房颤动（AF）的有效性和安全性仍存在争议。方法通过系统检索PubMed、Embase和Cochrane数据库，对截至2019年12月31日的所有相关研究进行荟萃分析。收集90天修正兰金量表（mRS） 0-1分、90天mRS 0-2分、总死亡率和症状性颅内出血（siich）发生率作为结局指标。采用固定效应和随机效应元分析模型，并评估研究间异质性。结果18项研究共纳入8509例患者。房颤与非房颤患者IVT治疗的比较显示，房颤与mr值为0-1的患者比例显著降低（24.1% vs. 34.5%; OR 0.59; 95% CI 0.43-0.81；P< 0.001）、mr值为0-2的患者比例显著降低（33.6% vs. 47.8%; OR 0.55; 95% CI 0.43-0.70；P< 0.001）、死亡率显著升高（19.4% vs. 11.5%; OR 2.05; 95% CI 1.79-2.36；P< 0.001）和siich发生率较高（6.4% vs. 4.1%; OR 1.60; 95% CI 1.27-2.01；P< 0.001）相关。对接受或未接受IVT治疗的房颤患者的比较显示，溶栓治疗发生sICH的风险较高（5.7% vs. 1.6%; or 3.44; 95% CI 2.04-5.82；P< 0.001），且与较好的预后无关。前瞻性研究的亚组分析也表明，与未接受IVT治疗的房颤患者相比，接受IVT治疗的房颤患者功能预后较差，死亡率较高。本荟萃分析中存在一些异质性。结论急性IS合并房颤患者溶栓治疗后预后差于非房颤患者，溶栓后siich发生率高于非溶栓患者。缺血性脑卒中合并房颤患者应结合NIHSS评分、年龄、房颤类型等临床因素慎重考虑溶栓。
BackgroundThe efficacy and safety of intravenous thrombolysis (IVT) for acute ischemic stroke with atrial fibrillation (AF) is still controversial.MethodsWe 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.ResultsA 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.ConclusionsAcute 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.
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影响因子：
8.3
作者：
Awadh, Mostafa;MacDougall, Niall;Muir, Keith W.
通讯作者：
Muir, Keith W.
影响因子：
8.3
作者：
WOLF, PA;ABBOTT, RD;KANNEL, WB
通讯作者：
KANNEL, WB
DOI：
10.1016/j.jstrokecerebrovasdis.2012.04.004
发表时间：
2014-01-01
影响因子：
2.5
作者：
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通讯作者：
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影响因子：
168.9
作者：
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通讯作者：
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影响因子：
1.9
作者：
Sung, Sheng-Feng;Chen, Yu-Wei;Lin, Huey-Juan
通讯作者：
Lin, Huey-Juan