Effect of Intravenous Tirofiban and Aspirin in Reducing Short-Term and Long-Term Neurologic Deficit in Patients with Ischemic Stroke: A Double-Blind Randomized Trial

Abstract

Background: Thrombolysis with rt-PA is the only approved pharmacological therapy for acute ischemic stroke presently administrable in a 3-hour window (very recently extended to 4.5 h). After this time, the choice is limited to endovascular treatment and antiplatelet drugs, mainly aspirin (ASA), the efficacy of which in the acute phase of stroke has poorly been evaluated. We compared the efficacy of tirofiban, a GP-IIb/IIIa inhibitor, and ASA, with both drugs being administered within 6 h. Methods: 150 patients were randomly assigned to treatment with tirofiban or ASA, both given for 3 days in a double-blind regimen. Major inclusion criteria were stroke onset within 6 h and a baseline National Institute of Health Stroke Scale (NIHSS) score of 5–25. Outcome variables were the proportion of patients with a NIHSS score reduction of ≧4 points after 72 h, and the proportion of patients with an mRS score of 0–1 at 3 months. Results: The trial, originally planned to enroll 300 patients, was halted after enrollment of 150 patients at interim analysis due to the lack of a trend difference between the 2 treatment groups. Neurological improvement at 72 h was observed in 56% of the patients in each group. At the 3-month follow-up, minimal or absent disability was seen in 45% of the patients in the tirofiban group and 53% in the ASA group; these differences were not statistically significant. Three-month mortality was the same in both groups (10.6%); the rates of symptomatic intracranial hemorrhage were 1% (tirofiban) and 4% (ASA). Conclusion: In spite of the fact that the null hypothesis was not supported by our data, we found results supporting the safety (and potential efficacy) of ASA and tirofiban when used in the first hours of acute ischemic stroke. However, this needs to be confirmed by further studies.

Potential for the Use of the Solitaire Stent for Recanalization of Middle Cerebral Artery Occlusion without a Susceptibility Vessel Sign

“…31 Because platelet activation is a key step in thromboembolism in the reocclusion of an in situ steno-occlusive lesion, [31][32][33][34] intravenous or intra-arterial glycoprotein IIb/IIIa inhibitors could be effective for preventing reocclusion. 32,34 On the basis of the findings of the Abciximab in Emergency Treatment of Stroke Trial, which showed an increased rate of symptomatic or fatal intracranial hemorrhage, 35 we used intravenous or intra-arterial tirofiban in our study only when no contraindication existed.…”

Abciximab Does Not Prevent Ischemic Lesions Related to Cerebral Angiography: A Randomized Placebo-Controlled Trial

“…The effect of glycoprotein IIb/IIIa receptor blockade in the prevention of infarcts during coronary intervention is well established in the literature [7,8,9,10,11,12,13]. Current studies investigate the efficacy of glycoprotein IIb/IIIa inhibition in the acute phase of stroke [14]. However, evidence for the superiority of the inhibition of platelet adhesion in the prevention of stroke during cerebral DSA is still needed.…”

A Pilot Trial of Low-Dose Intravenous Abciximab and Unfractionated Heparin for Acute Ischemic Stroke: Translating GP IIb/IIIa Receptor Inhibition to Clinical Practice

“…GP IIb/IIIa inhibitors have been tested in various protocols for the treatment of acute stroke with varying degrees of success [7,8,15,44,[51][52][53][54]. Our results indicate a low rate of complications in patients treated within the protocol described here and a suggestion of benefit when compared to a mathematically derived comparison group from the NINDS database.…”