Safety and efficacy of different tirofiban administration routes on acute ischemic stroke patients with successful recanalization: A propensity score matching analysis

Abstract

Objective This study aimed to explore the effect of different administration routes of a low dose of tirofiban on acute ischemic stroke (AIS) patients with successful recanalization after endovascular treatment (EVT). Methods This is a cohort study that retrospectively analyzed data of patients with AIS who underwent EVT and achieved successful recanalization from a prospective registry. Eligible patients were divided into three groups according to their use of tirofiban. Propensity score matching (PSM) was used to balance baseline bias. Safety outcomes included any intracranial hemorrhage (ICH) and symptomatic ICH (sICH). Efficacy outcomes included arterial reocclusion, in‐hospital mortality, 3‐month mortality, and 3‐month functional outcomes. Results We included 821 patients with 306 in the no tirofiban group, 202 in the IA + IV tirofiban group, and 313 in the IV tirofiban group. After PSM, each group included 101 patients with balanced baseline characteristics. There was no difference between the IV tirofiban group and the no tirofiban group in terms of safety and efficacy outcomes (all p > 0.05). Compared with no tirofiban, IA + IV tirofiban group did not increase ICH (30.7% vs. 37.6%, p > 0.05) and sICH (6.9% vs. 17.8%, p > 0.05) whereas reduced 3‐month mortality (14.3% vs. 28.7%, p < 0.05) and improved 3‐month modified Rankin Scale (median 3 vs. 4, p < 0.05). Conclusions A low dose of tirofiban, regardless of their administration routes, was safe for AIS patients who achieved successful recanalization with EVT, whereas only IA + IV tirofiban improved clinical outcomes.

Adjunct Intraarterial or Intravenous Tirofiban Versus No Tirofiban After Successful Recanalization of Basilar Artery Occlusion Stroke: The BASILAR Registry

“… 24 A full dose of intraarterial tirofiban (10 μg/kg) followed by continuous intravenous tirofiban led to a higher hemorrhagic risk compared with a full dose of intravenous tirofiban or no tirofiban, while a low dose of intraarterial+intravenous tirofiban improved the outcomes of patients with anterior circulation stroke after EVT. 11 , 16 The dose of tirofiban in this study was also relatively low, which was approximately identical to that in the study by Guo et al and assured the safety of the current dosing regimen of tirofiban. 16 …”

“… 20 However, most of these studies did not report detailed information about the dose or the duration of intraarterial tirofiban in their cohorts. 16 , 19 , 20 A recent study from Guo et al illustrated that half of the patients receiving intravenous tirofiban were also treated with intraarterial local tirofiban in clinical practice in China, and simultaneous intraarterial+intravenous tirofiban rather than intravenous tirofiban improved outcomes of patients with anterior circulation stroke. 16 In our preceding RESCUE‐BT trial, we found that intravenous tirofiban preceding thrombectomy failed to improve the clinical outcomes of patients with anterior circulation stroke.…”

“…In addition to patients receiving intravenous tirofiban alone, those who were treated with an intraarterial bolus of tirofiban 0.2 to 0.5 mg after arterial recanalization by EVT, and followed by an intravenous infusion of tirofiban up to 24 hours, were included in the present study. 16 …”

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

“…The effect of platelet aggregation blockade of tirofiban is dose‐dependent and can be rapidly reversible in 1.5–2.2 h 12 . Several studies have evaluated the efficacy of tirofiban in patients receiving EVT 13,14 . However, fewer studies have focused on the factors affecting the outcomes of the EVT followed by tirofiban in AIS patients.…”

“… 10 , 11 The effect of platelet aggregation blockade of tirofiban is dose‐dependent and can be rapidly reversible in 1.5–2.2 h. 12 Several studies have evaluated the efficacy of tirofiban in patients receiving EVT. 13 , 14 However, fewer studies have focused on the factors affecting the outcomes of the EVT followed by tirofiban in AIS patients. In this study, we performed exploratory analyses regarding factors influencing functional outcomes in AIS patients who received adding tirofiban to EVT.…”