Safety of bridging antiplatelet therapy with the gpIIb-IIIa inhibitor tirofiban after emergency stenting in stroke

Abstract

BackgroundIn a proportion of stroke patients with acute large vessel occlusion permanent stent implantation is mandatory to achieve successful recanalization. The optimum platelet inhibition strategy after such emergency stenting is unknown. We therefore analyzed the outcome of early glycoprotein (gp) IIb/IIIa inhibitor treatment after emergency stenting in acute stroke.MethodsSixty patients with emergency stenting were identified in our stroke unit registry from 12/2010-06/2014 and analyzed retrospectively. All patients were bridged intravenously with the gpIIb/IIIa antagonist tirofiban immediately after the acute procedure until switching to oral aspirin and clopidogrel was performed. For comparison we studied 135 patients with M1 occlusion undergoing thrombectomy without stent implantation or tirofiban treatment in a propensity score-adjusted analysis.ResultsIn the acute stenting group receiving tirofiban complications with 6 deaths during the hospital stay (10%), 2 reinfarctions (3%), 12 intracerebral hemorrhages (ICH; 20%) and 5 symptomatic ICH (8%) occurred. Thirty-seven patients (62%) reached a moderate outcome of mRS 0–3 after 90 days. In the thrombectomy group without tirofiban administration the rate of deaths within hospital stay, the rate of ICH and outcome at day 90 were not different.ConclusionIn our retrospective study acute stenting with subsequent gpIIb/IIIa inhibition was not associated with an increased risk of ICH or in-hospital death.

Safety and Efficacy of Tirofiban in Acute Ischemic Stroke Patients Receiving Endovascular Treatment: A Meta-Analysis

“…We retrieved 1,213 articles that were potentially pertinent. After removing duplicates and reviewing titles and abstracts to exclude irrelevant studies, case reports, and reviews, 11 cohort trials [10][11][12][13][14][15][16][17][18][19][20] fulfilled all the inclusion criteria and included 2,028 patients ( Fig. 1).…”

“…In case of heterogeneity (I 2 > 50% or p ≤ 0.10), we attempted to identify and explain it by using subgroup analysis [25]. Sensitivity analysis was performed separately by excluding the study with the largest sample size [19], excluding the study with the smallest sample size [10], then excluding the only one study indicating significant difference in sICH [17], and excluding one study indicating significant difference in recanalization rate between the tirofiban group and without the tirofiban group [14]. Funnel plots and Begg's linear regression test were used to evaluate publication bias.…”

“…The overall recanalization occurrence was 1,670 (82.3%), of which 591 (83.9%) connected with the tirofiban group and 1,079 (81.5%) pertain to the without tirofiban group. One study [14] showed a significantly increased recanalization rate in the tirofiban group compared with the without tirofiban group (p = 0.026). There was also 1 study [11] that illuminated preoperative tirofiban can increase the recanalization rate (p = 0.004).…”

“…However, as an off-label usage, Cerebrovasc Dis 2020;49:442-450 DOI: 10.1159/000509054 whether tirofiban increases the bleeding risk or improves the outcome of ET in AIS is unknown. There were several studies that evaluated the feasibility of tirofiban in AIS patients receiving ET, and the results were conflicting [10][11][12][13][14][15][16][17][18][19][20]. Thus, we aimed to perform a meta-analysis to evaluate the safety and efficacy of tirofiban in combination with ET for AIS patients.…”

Rescue Therapy in Endovascualr Treatment for Acute Ischemic Stroke Due to Large Artery Atherosclerosis

“…Because the stroke cause of all enrolled patients with acute ischemic stroke in this study were large artery atherosclerosis based on TOAST classification. Tirofiban as the main anti-platelet therapy was injected through intravenous treatment in this single center [22].…”