Cerebral Microembolism Is Blocked by Tirofiban, a Selective Nonpeptide Platelet Glycoprotein IIb/IIIa Receptor Antagonist

Junghans, Ulrich; Siebler, Mario

doi:10.1161/01.cir.0000070544.15890.0e

Cited by 75 publications

(55 citation statements)

References 44 publications

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“…Microembolus signals detected with TCD include blood clots, platelet aggregated particles, arteriosclerosis plaque particles (platelets, fibrinogen, cholesterol), and fat or air. However, the majority of microemboli from artery cerebral infarction were particles enriched in platelets that were caused by the rupture of atherosclerosic unstable plaques (Goertler et al, 2002;Junghans and Siebler, 2003). Sitzer et al (1995) found that atherosclerotic plaques and intraluminal thrombus from carotid ulcerations were the main source of microemboli.…”

Section: Discussionmentioning

confidence: 99%

A study of microemboli monitoring of atherosclerotic thrombotic cerebral infarction and artery stenosis

Sun¹,

Zhuang²,

Zeng³

et al. 2014

Genet. Mol. Res.

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ABSTRACT. This study aimed to assess the relationship between the recurrence and prognosis of patients with acute middle cerebral artery infarction, atherosclerotic brain infarction, and the existence of microemboli. We continuously enrolled patients with acute atherosclerotic thrombotic cerebral infarction artery stenosis. We performed transcranial Doppler color ultrasound micro emboli monitoring, color Doppler ultrasound carotid artery tests, intracranial Microemboli monitoring study and carotid artery magnetic resonance angiography, impairment evaluation of nerve function, and registration of stroke recurrence and stroke mortality. Of the 49 patients enrolled in the study, 123 main arteries presented atherosclerotic stenosis or formed plaques, and 33 patients had symptomatic stenosis. Patients with symptomatic stenosis have a higher incidence of microemboli than patients with asymptomatic stenosis (P = 0.009). The microembolus-positive rate increased in patients with unstable plaques (P = 0.001). Patients who were microembolus-negative were more likely to show a neural function deficient NIHSS (National Institutes of Stroke Scale) score improvement than patients who were microembolus-positive at one week (P = 0.026). However, we found no significant difference between mRS (modified rankin scale) score (P = 0.319), relapse, and death (P = 0.179). The rate of microembolus-positivity increased in patients with atherosclerotic thrombotic cerebral infarction and unstable plaques. Patients who were microembolus-negative were more likely to show an improvement of neural function deficiency than patients with microembolus-positivity at one week (P = 0.026).

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Section: Discussionmentioning

confidence: 99%

A study of microemboli monitoring of atherosclerotic thrombotic cerebral infarction and artery stenosis

Sun¹,

Zhuang²,

Zeng³

et al. 2014

Genet. Mol. Res.

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“…7,10 Tirofiban is a fast-acting, fast-deactivated, highly selective nonpeptide gpIIb/IIIa antagonist approved by the Food and Drug Administration for the treatment of acute coronary syndrome up to 48 hours after onset. 11,12 Pilot studies in a small number of patients with stroke showed that tirofiban abolished cerebral microemboli in patients with symptomatic carotid lesions 13,14 and reduced infarct lesions as assessed with MR perfusion imaging and diffusion-weighted imaging. 15 However, to test the efficacy of tirofiban in a multicenter acute stroke trial with a longer time window, it is necessary to assess the safety of tirofiban.…”

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confidence: 99%

Safety of Tirofiban in Acute Ischemic Stroke

Siebler

Hennerici

Schneider

et al. 2011

Stroke

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143

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Background and Purpose— Tirofiban is a highly selective, fast-acting nonpeptide glycoprotein IIb/IIIa platelet receptor antagonist with a short half-life time. Glycoprotein IIb/IIIa antagonists are effective for the treatment of acute coronary syndromes proven in large clinical trials. Safety and efficacy in patients with ischemic stroke are uncertain. This was addressed in the Safety of Tirofiban in acute Ischemic Stroke (SaTIS) trial. Methods— Two hundred sixty patients with acute ischemic stroke were randomized in a placebo-controlled, prospective, open-label treatment, blinded outcome reading multicenter trial. Subjects with a National Institutes of Health Stroke Scale between 4 and 18 received intravenously either tirofiban or placebo within 3 to 22 hours after symptom onset for 48 hours. The primary end point was the rate of cerebral bleeding as measured in follow-up CT scans 2 to 7 days after inclusion. The secondary end point was clinical efficacy within 1 week (National Institutes of Health Stroke Scale, modified Rankin Scale) and after 5 months (Barthel Index, modified Rankin Scale). Results— The rate of cerebral hemorrhagic transformation (I/II) and parenchymal hemorrhage (I/II) did not differ between both groups (tirofiban 36 of 120; placebo 33 of 124: OR, 1.18; 95% CI, 0.66 to 2.06). Mortality after 5 months was significantly lower in patients treated with tirofiban (3 of 130 [2.3%] versus 11 of 126 [8.7%]; OR, 4.05; 95% CI, 1.1 to 14.9). No difference in neurological/functional outcome was found after 1 week and after 5 months. Conclusions— We conclude that tirofiban might be safe in acute moderate ischemic stroke even when administered within a large time window after symptom onset and might save lives in the late outcome. Clinical Trial Registration— URL: www.strokecenter.org/trials/ . Trial name: SaTIS. Enrollment began before July 1, 2005.

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“…Therefore, their measurement may be used as a surrogate marker for evaluating anti-platelet effect (Wong 2005). Glycoprotein IIb/IIIa receptor antagonist such as tirofiban infusion has shown to reduce the rate of microemboli and the effect was reversible with the cessation of infusion (Junghans and Siebler 2003). Administration of intravenous and oral acetylsalicyclic acid (ASA) has shown to reduce the frequency of microemboli rapidly (Goertler, Baeumer et al 1999;Goertler, Blaser et al 2001).…”

Section: Assessing Efficacy Of Secondary Prophylaxismentioning

confidence: 99%