Cerebral Microbleeds and Chronic Kidney Disease in Acute Ischemic Stroke Patients with Atrial Fibrillation

Background and Purpose: Cerebral microbleeds (CMBs) are now considered to be one of the neuroimaging markers of cerebral small vessel disease. It has been reported that CMBs are associated with age, hypertension, cognitive impairment, and use of antithrombotic drugs. We aimed at identifying factors associated with the presence of CMBs among acute ischemic stroke patients with non-valvular atrial fibrillation (NVAF) who participated in the multicenter Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-NVAF study. Methods: Acute ischemic stroke/transient ischemic attack (within 7 days of onset) patients with NVAF who underwent T2*-weighted images on magnetic resonance imagings at baseline were included in the analysis. Factors associated with the presence of CMBs were assessed in univariable and multivariable logistic regression models. Results: Of 1,099 (77.6±10.0 years, 620 male) participants, 256 (23.2%) had CMBs: single CMB in 96 (8.7%), 2-4 of CMBs in 109 (9.9%), and ≥5 CMBs in 51 (4.6%). The presence of CMBs was associated with age [per 10 years, odds ratio (OR) 1.21; 95% confidence interval (CI) 1.02-1.44], past history of stroke (OR 1.52; 95% CI 1.09-2.11), and advanced cognitive impairment (OR 1.64; 95% CI 1.02-2.61) in multivariable analysis adjusted for sex, hypertension, arterial disease, ever smoking, premorbid antithrombotic medications, and estimated glomerular filtration rate. Among 514 patients (46.8% of the participants) with the data of urinary albumin, clinical albuminuria (urinary albumin ≥300 mg/gCr) and past history of stroke were identified as independent factors associated with CMBs (OR 1.91; 95% CI 1.06-3.42 and 1.67; 1.04-2.66, respectively). Conclusions: Approximately one fourth of acute ischemic stroke patients with NVAF had CMBs. Past history of stroke and clinical albuminuria were identified as independent determinants of CMBs on top of established ones. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01581502.

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High Serum Alkaline Phosphatase Levels in Relation to Multi-Cerebral Microbleeds in Acute Ischemic Stroke Patients with Atrial Fibrillation and/or Rheumatic Heart Disease

Current Neurovascular Research ◽

10.2174/1567202613666160817095623 ◽

2016 ◽

Vol 13 (4) ◽

pp. 303-308 ◽

Cited By ~ 2

Author(s):

Junfeng Liu ◽

Deren Wang ◽

Jie Li ◽

Yao Xiong ◽

Bian Liu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Alkaline Phosphatase ◽

Heart Disease ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Rheumatic Heart Disease ◽

Serum Alkaline Phosphatase ◽

High Serum ◽

Stroke Patients ◽

Rheumatic Heart

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Resting Heart Rate and In-Hospital Mortality in Acute Ischemic Stroke Patients With and Without Atrial Fibrillation

Circulation Journal ◽

10.1253/circj.cj-19-0946 ◽

2020 ◽

Vol 84 (4) ◽

pp. 656-661

Author(s):

Qiao Han ◽

Chunyuan Zhang ◽

Shoujiang You ◽

Danni Zheng ◽

Chongke Zhong ◽

...

Keyword(s):

Atrial Fibrillation ◽

Heart Rate ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Resting Heart Rate ◽

Stroke Patients

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Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽

10.1161/str.45.suppl_1.176 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Tae-Jin Song ◽

Jinkwon Kim ◽

Dongbeom Song ◽

Yong-Jae Kim ◽

Hyo Suk Nam ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Hemorrhagic Stroke ◽

Independent Predictor ◽

Stroke Patients ◽

Risk Of Death ◽

Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

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Abstract 1122‐000214: Clinical Factors Associated rTPA Administration in Acute Ischemic Stroke Patients with History of Atrial Fibrillation

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000214 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Chase A Rathfoot ◽

Camron Edressi ◽

Carolyn B Sanders ◽

Krista Knisely ◽

Nicolas Poupore ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Medical History ◽

Clinical Decision Making ◽

Past Medical History ◽

Clinical Factors ◽

Stroke Patients ◽

Factors Associated ◽

History Of

Introduction : Previous research into the administration of rTPA therapy in acute ischemic stroke patients has largely focused on the general population, however the comorbid clinical factors held by stroke patients are important factors in clinical decision making. One such comorbid condition is Atrial Fibrillation. The purpose of this study is to determine the clinical factors associated with the administration of rtPA in Acute Ischemic Stroke (AIS) patients specifically with a past medical history of Atrial Fibrillation (AFib). Methods : The data for this analysis was collected at a regional stroke center from January 2010 to June 2016 in Greenville, SC. It was then analyzed retrospectively using a multivariate logistic regression to identify factors significantly associated with the inclusion or exclusion receiving rtPA therapy in the AIS/AFib patient population. This inclusion or exclusion is presented as an Odds Ratio and all data was analyzed using IBM SPSS. Results : A total of 158 patients with Atrial Fibrillation who had Acute Ischemic Strokes were identified. For the 158 patients, the clinical factors associated with receiving rtPA therapy were a Previous TIA event (OR = 12.155, 95% CI, 1.125‐131.294, P < 0.040), the administration of Antihypertensive medication before admission (OR = 7.157, 95% CI, 1.071‐47.837, P < 0.042), the administration of Diabetic medication before admission (OR = 13.058, 95% CI, 2.004‐85.105, P < 0.007), and serum LDL level (OR = 1.023, 95% CI, 1.004‐1.042, P < 0.16). Factors associated with not receiving rtPA therapy included a past medical history of Depression (OR = 0.012, 95% CI, 0.000‐0.401, P < 0.013) or Obesity (OR = 0.131, 95% CI, 0.034‐0.507, P < 0.003), Direct Admission to the Neurology Floor (OR = 0.179, 95% CI, 0.050‐0.639, P < 0.008), serum Lipid level (OR = 0.544, 95% CI, 0.381‐0.984, P < 0.044), and Diastolic Blood Pressure (OR = 0.896, 95% CI, 0.848‐0.946, P < 0.001). Conclusions : The results of this study demonstrate that there are significant associations between several clinical risk factors, patient lab values, and hospital admission factors in the administration of rTPA therapy to AIS patients with a past medical history of Atrial Fibrillation. Further research is recommended to determine the extent and reasoning behind of these associations as well as their impact on the clinical course for AIS/AFib patients.

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Novel composite scoring system to predict unknown atrial fibrillation in acute ischemic stroke patients

Brain Research ◽

10.1016/j.brainres.2017.08.005 ◽

2017 ◽

Vol 1674 ◽

pp. 36-41 ◽

Cited By ~ 1

Author(s):

Rixia Liu ◽

Xiaomeng Yang ◽

Shuya Li ◽

Yong Jiang ◽

Yilong Wang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Scoring System ◽

Stroke Patients

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Abstract P12: Alteplase Reduces Mortality in Patients With Ischemic Stroke and Atrial Fibrillation: Analysis of the IAC Study

Stroke ◽

10.1161/str.52.suppl_1.p12 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Shadi Yaghi ◽

Eva Mistry ◽

Adam H De Havenon ◽

Christopher Leon Guerrero ◽

Amre Nouh ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Infarct Volume ◽

Intravenous Thrombolysis ◽

The United States ◽

Hemorrhagic Transformation ◽

Stroke Patients ◽

Increased Risk ◽

Significant Difference

Background and Purpose: Multiple studies have established that intravenous thrombolysis with alteplase improves outcome after acute ischemic stroke. However, assessment of thrombolysis’ efficacy in stroke patients with atrial fibrillation (AF) has yielded mixed results. We sought to determine the association of alteplase with mortality, hemorrhagic transformation (HT), infarct volume, and mortality in patients with AF and acute ischemic stroke. Methods: We retrospectively analyzed consecutive acute ischemic stroke patients with AF included in the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study, which pooled data from 8 comprehensive stroke centers in the United States. 1889 (90.6%) had available 90-day follow up data and were included. For our primary analysis we used a cohort of 1367/1889 (72.4%) patients who did not undergo mechanical thrombectomy (MT). Secondary analyses were repeated in the patients that underwent MT (n=522). Binary logistic regression was used to determine whether alteplase use was independently associated with risk of HT, final infarct volume, and 90-day mortality, respectively, adjusting for potential confounders. Results: In our primary analyses we found that alteplase use was independently associated with an increased risk for HT (adjusted OR 2.14, 95% CI 1.49 - 3.07, p <0.001) but overall reduced risk of 90-day mortality (adjusted OR 0.58, 95% CI 0.39 - 0.87, p = 0.009). Among patients undergoing MT, alteplase use was associated with a trend towards a reduction in 90-day mortality (adjusted OR 0.68 95% CI 0.45 - 1.04, p = 0.077). In the subgroup of patients prescribed DOAC treatment (n = 327; 24 received alteplase), alteplase treatment was associated with a trend towards smaller infarct size (< 10 mL), (adjusted OR 0.40, 95% CI 0.15 - 1.12, p = 0.082) without a significant difference in the odds of 90-day mortality (adjusted OR 0.51, 95% CI 0.12 - 2.13, p = 0.357) or hemorrhagic transformation (adjusted OR 0.27, 95% CI 0.03 - 2.07, p = 0.206). Conclusion: Thrombolysis with intravenous alteplase was associated with reduced 90-day mortality in AF patients with acute ischemic stroke not undergoing MT. Further study is required to assess the safety and efficacy of alteplase in AF patients undergoing MT and those on DOACs.

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