Association of newly diagnosed atrial fibrillation with remote intracerebral hemorrhage after intravenous thrombolysis: Results from a multicenter study in China

Objective To investigate the association of atrial fibrillation (AF), especially newly diagnosed AF, with remote intracerebral hemorrhage (rICH) in patients with ischemic stroke treated by intravenous thrombolysis. Methods This is an observational study of patients with ischemic stroke who were treated with intravenous thrombolysis with recombinant tissue-type plasminogen activator whose data were taken from a multicenter prospective registry of a Chinese population. RICH was defined as any extraischemic hemorrhage detected by imaging examination ≤ 24 hours after intravenous thrombolysis. We collected the demographic data and clinical characteristics of all the patients. We compared patients with rICH and those without any type of hemorrhagic transformation. The association of AF and rICH was analyzed by univariate analysis and binary logistic regression. Results We evaluated 20697 patients, 1566 (7.6%) of whom developed intracerebral hemorrhage (ICH), 586 (2.8%) of whom experienced rICH, and 19131 (92.4%) of whom did not experience any type of hemorrhagic transformation. Univariate analysis showed that there were significant differences in age, prethrombolysis systolic blood pressure, baseline NIHSS score, known AF, newly diagnosed AF, coronary heart disease, congestive heart failure, hyperhomocysteinemia and history of thrombolysis between the rICH and control groups (P < 0.05). Further multivariate logistic regression analysis showed that total AF [OR 1.821, (95%CI, 1.082-3.065), P < 0.05], known AF [OR 1.470, (95%CI, 1.170-1.847)] and newly diagnosed AF [OR 1.920, (95%CI, 1.304-2.825)] were all independently associated with rICH. Conclusions This study suggests that AF (regardless of the newly diagnosed or known AF) may be associated with the occurrence of rICH after intravenous thrombolysis. Interestingly, newly diagnosed AF may have a greater impact on rICH than known AF, but that finding needs to be confirmed by a larger prospective sample. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by the National Natural Science Foundation of China (81971101, 82171276), the Science Technology Department of Zhejiang Province (2018C04011), and the Science and Technology Plan of Jinhua City (2020-3-026, 2021-3-087). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was reviewed by the Ethics Committee of the Second Affiliated Hospital of Zhejiang University School of Medicine (2016 Annual Ethics Review No. 074). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Not Applicable The data underlying this article will be shared on reasonable request to the corresponding author. * Abbreviations: AF : atrial fibrillation rICH : remote intracerebral hemorrhage ICH : intracerebral hemorrhage IVT : intravenous thrombolysis HT : hemorrhage transformation rt-PA : recombinant tissue plasminogen activator CHD : coronary heart disease CHF : congestive heart failure Hcy : hyperhomocysteinemia OTT : onset to treatment time NIHSS : National Institutes of Health Stroke Scale TOAST : Trial of Org 10172 in Acute Stroke Treatment ECG : electrocardiogram HI : hemorrhagic infarct PH : parenchymal hemorrhage WMHs : white matter hyperintensities CMBs : cerebral microbleeds;