Early tirofiban administration for patients with acute ischemic stroke treated with intravenous thrombolysis or bridging therapy: Systematic review and meta-analysis

Liu, Qianqian; Lu, Xianfu; Ye, Hong; Deng, Shuai; Zhang, Jian; Chen, Shijian; Shi, Shengnan; Xun, Weiquan; Peng, Rihong; Lin, Bei; Li, Tao; Pan, Liya; Weng, Baohui

doi:10.1016/j.clineuro.2022.107449

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…When used in combination with intravenous thrombolysis, tirofiban does not increase adverse reactions either [20]. In AIS patients who received intravenous thrombolysis or bridging therapy, there was no increased risk of sICH, ICH, or death rate and the early injection of tirofiban improved the 90 -day favorable (mRS ≤ 2) prognosis, indicating that it may be effective and safe [21]. The adverse reaction of cerebral hemorrhage in acute ischemic stroke patients may be related to an NIHSS scores greater than 15 points [17].…”

Section: Discussionmentioning

confidence: 98%

Safety and efficacy of arterial injection of tirofiban in treating ischemic stroke beyond the window period

Rong,

Chen,

et al. 2023

Trop. J. Pharm Res

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Purpose: To investigate the efficacy of intraarterial administration of tirofiban for stroke treatment beyond the conventional window period and evaluate its impact on prognosis.Methods: A retrospective study was conducted on ninety (90) acute ischemic stroke patients admitted to The First Affiliated Hospital of Hainan Medical University, Haikou, China from July 2021 to October 2022. The patients were divided into Tirofiban group (50) and non-Tirofiban group (40) based on whether the patients received arterial clopidogrel. National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel index (BI) scores were used to evaluate adverse drug reactions and its impact on prognosis for patients with symptoms onset within 6 - 24 h.Results: No significant differences were observed between the groups in terms of age, gender, medical history, personal history, blood indicators and neurologic function scores (p > 0.05). The median NIHSS score on admission and after 24 h of treatment was 4 in both groups and 3 in both groups after 72 h of treatment. However, after 7 days of treatment, the median NIHSS score was lower in Tirofiban group (2.0) than in non-Tirofiban group (2.5; p > 0.05). Tirofiban group demonstrated higher rates of effective treatment and good prognosis compared to non-Tirofiban group. Importantly, there was no significant difference in the occurrence of adverse reactions between the two groups (p > 0.05).Conclusion: Tirofiban, given via the arteries, improves neurological functions following hyper-acute stroke even beyond the window period and without adverse reactions. It is a safe and effective antiplatelet drug for late-life treatment. For future studies, it will be necessary to broaden the treatment scope and gather more robust and reliable data in order to enhance data quality.

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Section: Discussionmentioning

confidence: 98%

Safety and efficacy of arterial injection of tirofiban in treating ischemic stroke beyond the window period

Rong,

Chen,

et al. 2023

Trop. J. Pharm Res

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“…These results are consistent with the findings of a meta-analysis which included 722 patients with IVT bridging therapy from three trials, and 846 patients with IVT alone from seven studies published between 2001 and 2021. Pooled results showed that early tirofiban administration with IVT or bridging therapy did not increase the risks of sICH and ICH [ 29 ]. However, it was demonstrated that tirofiban, as an adjunct to thrombectomy, increased fatal bleeding risk in a dose-dependent manner [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Tirofiban Use in Endovascular Thrombectomy for Intravenous Thrombolysis Applicable Patients with Large Vessel Occlusion Stroke—a Post Hoc Analysis from the Direct-MT Trial

Zhang,

Tao

et al. 2023

Cardiovasc Intervent Radiol

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Purpose The purpose of the study was to evaluate the efficacy and safety of tirofiban use in endovascular thrombectomy for intravenous thrombolysis applicable patients of large vessel occlusion stroke with data from Direct-MT trial. Materials and Methods Direct-MT was the first randomized controlled trial to prove the non-inferiority of thrombectomy alone to bridging therapy (intravenous thrombolysis before thrombectomy) for large vessel occlusion stroke. Patients who underwent endovascular procedure were included and divided into thrombectomy-alone group and bridging therapy group. The effect of tirofiban use on 90 days MRS distribution, MRS 0–2 and mortality, successful reperfusion, the ASPECTS and outcome lesion volume of index stroke, re-occlusion of the treated vessel, futile recanalization and safety outcomes were further evaluated in both groups after adjustment for relevant confounding factors. The interaction between tirofiban and rt-PA was also assessed. Results Of 639 patients included in this analysis, 180 patients underwent thrombectomy with tirofiban use (28.2%). Patients with tirofiban use had lower percentage of bridging therapy (41.1% vs 54.3%, P = 0.003), higher proportion of large artery atherosclerosis (P < 0.001) and more emergent stenting (30.56% vs 6.97%, P < 0.001). After adjustment for confounding factors, the 90-day modified Rankin Scale distribution, successful final recanalization rate, outcome lesion volume of index stroke on CT and intracranial hemorrhage risk showed no difference after tirofiban use in thrombectomy-alone group and in bridging therapy group. No interaction effect between tirofiban and rt-PA was detected. Conclusion Based on data from Direct-MT trial, tirofiban is a safe medication for intravenous thrombolysis applicable patients with large vessel occlusion stroke undergoing thrombectomy. Level of Evidence Level 3, cohort study of randomized trial.

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Treatment of Acute Ischemic Stroke

Harrigan,

Deveikis

2023

Contemporary Medical Imaging

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Early tirofiban administration for patients with acute ischemic stroke treated with intravenous thrombolysis or bridging therapy: Systematic review and meta-analysis

Cited by 5 publications

References 26 publications

Safety and efficacy of arterial injection of tirofiban in treating ischemic stroke beyond the window period

Safety and efficacy of arterial injection of tirofiban in treating ischemic stroke beyond the window period

The Efficacy and Safety of Tirofiban Use in Endovascular Thrombectomy for Intravenous Thrombolysis Applicable Patients with Large Vessel Occlusion Stroke—a Post Hoc Analysis from the Direct-MT Trial

Treatment of Acute Ischemic Stroke

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