Intravenous tirofiban therapy for patients with capsular warning syndrome

Abstract

BackgroundCapsular warning syndrome (CWS) is defined as recurrent episodes of transient ischaemic attacks ≥3 times during a short time frame. There is no effective therapy to stop these attacks. We, herein, report our experience of using intravenous tirofiban to treat CWS.MethodsAll patients with CWS in our hospital from January 2013 to September 2017 were reviewed. Patients in tirofiban group (T-group) were treated by intravenous tirofiban at 0.4 μg/kg/min for 30 min followed by 0.1–0.15 µg/kg/min infusion. Other treatments (non-T-group) included thrombolytic, oral antiplatelet agents and anticoagulant. Intracerebral haemorrhage (ICH), systematic bleeding, new attacks after treatment, National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours and modified Rankin Scales (mRSs) at 3 months were recorded. Descriptive statistics were used for analysis.ResultsOf 23 patients qualified (15 in T-group, 8 in non-T-group), the duration of symptoms ranged from 2 to 100 min before treatments. After treatment, in T-group, four patients (26.7%) had recurrent attacks, and NIHSS scores were 0 in 11 patients (73.3%) at 24 hours. All patients reached a favourable outcome (mRS ≤2 at 3 months. In non-T-group, five patients (62.5%) had new attacks. NIHSS scores were 0 in two patients (25%) at 24 hours. At 3 months, seven patients (87.5%) reached a favourable outcome. Neither ICH nor systematic bleeding or thrombocytopaenia occurred in both groups of patients.ConclusionsIntravenous tirofiban can be a potentially effective and safe therapy to stop early symptomatic fluctuations and shorten the duration of functional deficits in patients with CWS.

Salvage Therapy after Early Neurological Deterioration in Patients with Branch Atheromatous Disease Receiving Dual Antiplatelet Therapy

“…These stereotypical attacks might be caused by the "thrombotic" process and overactivation of platelets [27][28]. The observational study of Meng [29] showed that intravenous tiro ban appeared to be effective and safe in stopping recurrent and uctuating symptoms in patients with capsular warning syndrome(CWS) and in improving the three-month prognosis. It has been suggested that tiro ban, via a more fast-acting and powerful action on the cerebral cortex, may help prevent CWS from progressing to infarction.…”

Treatment of progressive ischemic stroke with low‑dose eptifibatide: A retrospective case‑control study

“…SAO is a common cause of capsular warning syndrome (CWS), since CWS is most often due to small penetrating vessel hemodynamic disorder ( 25 , 26 ). A previous study on tirofiban showed that it could stop early symptomatic fluctuations and decrease the duration of functional impairments in patients with CWS compared with oral antiplatelet drugs ( 27 ). In addition, there is evidence that tirofiban is safe and efficacious in patients with ischemic stroke outside the thrombolytic therapy window compared with oral antiplatelet medications ( 28 ).…”

A Case of Atypical Capsular Warning Syndrome of Long Duration

“…Favorable outcomes using dual antiplatelet drugs (aspirin and clopidogrel) were reported in CWS 7,14) ; however, a confirmed therapeutic strategy in patients with CWS is uncertain 3) . In the preventive treatment of our patient, one or two antiplatelets agents were administered until the sixth hospitalization.…”