Factors affecting the outcomes of tirofiban after endovascular treatment in acute ischemic stroke: Experience from a single center

Wang, Yuan; Ma, Hongrui; Zhang, Qihan; Fan, Jian; Xu, Yi; Ma, Qingfeng; Ji, Xunming

doi:10.1111/cns.14058

Cited by 3 publications

(2 citation statements)

References 65 publications

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“…This approach would enable the identification of patients who are more likely to experience bleeding complications and facilitate the implementation of appropriate risk mitigation strategies. However, studies by X. Pan et al and Y. Wang et al provide conflicting results regarding the safety of tirofiban in endovascular stroke treatment [ 12 , 22 ]. X. Pan et al evaluated the safety and efficacy of tirofiban as adjunctive therapy in patients with acute vertebrobasilar artery occlusion undergoing mechanical thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

Association of tirofiban treatment with outcomes following endovascular therapy in cardioembolic stroke: insights from the RESCUE BT randomized trial

Rong,

Guo,

Gao

et al. 2023

Eur J Med Res

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Background and purpose The efficacy and safety of tirofiban in endovascular therapy for cardioembolic ischemic stroke patients remain controversial. This study aimed to evaluate the role of intravenous tirofiban before endovascular therapy in cardioembolic stroke. Methods This post hoc analysis utilized data from the RESCUE BT (Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke) trial, which was an investigator-initiated, randomized, double-blind, placebo-controlled trial. Participants were randomized to receive either tirofiban or a placebo in a 1:1 ratio before undergoing endovascular therapy. The study included patients aged 18 years or older, presenting with occlusion of the internal carotid artery or middle cerebral artery (MCA) M1/M2 within 24 h of the last known well time, and with a stroke etiology of cardioembolism. The primary efficacy outcome was global disability at 90 days, assessed using the modified Rankin Scale (mRS). The safety outcome included symptomatic intracranial hemorrhage (sICH) within 48 h and mortality within 90 days. Results A total of 406 cardioembolic stroke patients were included in this study, with 212 assigned to the tirofiban group and 194 assigned to the placebo group. Tirofiban treatment did not correlate with a favorable shift towards a lower 90-day mRS score (adjusted common odds ratio [OR], 0.91; 95% CI 0.64–1.3; p = 0.617). However, the tirofiban group had a significantly higher risk of symptomatic intracranial hemorrhage (sICH) within 48 h (adjusted OR, 3.26; 95% CI 1.4–7.57; p = 0.006) compared to the placebo group. The adjusted odds ratio (aOR) for mortality within 90 days was 1.48 (95% CI 0.88–2.52; p = 0.143). Conclusions Tirofiban treatment was not associated with a lower level of disability and increased the incidence of sICH after endovascular therapy in cardioembolic stroke patients.

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Section: Discussionmentioning

confidence: 99%

Association of tirofiban treatment with outcomes following endovascular therapy in cardioembolic stroke: insights from the RESCUE BT randomized trial

Rong,

Guo,

Gao

et al. 2023

Eur J Med Res

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“…However, for patients outside the thrombolytic time window, there is currently no better treatment option. Studies have shown that tirofiban is an effective treatment for acute ischemic stroke and it is beneficial for the recovery of neurological function [4].…”

Section: Introductionmentioning

confidence: 99%

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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Factors affecting the outcomes of tirofiban after endovascular treatment in acute ischemic stroke: Experience from a single center

Wang

Zhang

et al. 2023

CNS Neurosci Ther

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Aims To investigate the predicted factors influencing the outcomes in acute ischemic stroke (AIS) patients who received tirofiban after endovascular treatment (EVT) and the optimal administration of tirofiban. Methods In this retrospective study, AIS patients who received EVT followed by tirofiban between January 2017 and October 2021 were enrolled. The dose and duration of tirofiban were adjusted by trained clinicians according to the patient's clinical status. A reduction of at least four points on the National Institutes of Health Stroke Scale (NIHSS) after tirofiban compared with that before tirofiban was defined as an effective response. A modified ranking scale (mRS) of 0–2 was defined as a favorable outcome at a 90‐day follow‐up. Results A total of 260 consecutive patients were enrolled, and 36.5% of patients achieved a favorable outcome. The modified thrombolysis in cerebral infarction (mTICI) 2b‐3 occurred in 93.5% of patients. Symptomatic intracerebral hemorrhage (sICH) occurred in 6.2% of patients, and the mortality at 90‐day follow‐up was 16.9%. Duration of tirofiban >24 h (adjusted OR: 2.545; 95% CI: 1.008–6.423; p = 0.048) and effective response to tirofiban (adjusted OR: 25.562; 95% CI: 9.794–66.715; p < 0.001) were related to the favorable outcome (mRS 0–2). Higher NIHSS (adjusted OR: 0.855; 95% CI: 0.809–0.904; p < 0.001) and glucose level on admission (adjusted OR: 0.843; 95% CI: 0.731–0.971; p = 0.018) were predictive for the unfavorable outcome (mRS 3–6). Conclusions An effective response to tirofiban is an independent factor in predicting the long‐term efficacy outcome, and extending the duration of tirofiban is beneficial for neurological improvement.

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Factors affecting the outcomes of tirofiban after endovascular treatment in acute ischemic stroke: Experience from a single center

Cited by 3 publications

References 65 publications

Association of tirofiban treatment with outcomes following endovascular therapy in cardioembolic stroke: insights from the RESCUE BT randomized trial

Association of tirofiban treatment with outcomes following endovascular therapy in cardioembolic stroke: insights from the RESCUE BT randomized trial

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

Factors affecting the outcomes of tirofiban after endovascular treatment in acute ischemic stroke: Experience from a single center

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