Safety of tirofiban for patients with acute ischemic stroke in routine clinical practice

Abstract

Abstract. The aim of the present study was to investigate the safety of tirofiban alone and in combination with various treatments in acute ischemic stroke (AIS). A total of 120 patients with AIS were included in the study, and these patients were divided into three treatment groups: Group A (tirofiban alone, n=68), group B (tirofiban plus thrombolytic therapy, n=26), and group C (tirofiban as a 'bridging therapy', n=26). Risk factors, stroke severity, initial imaging, treatment regimens, complications and long-term outcomes were analyzed. In total, eight patients (6.7%) [six patients (23.1%) in group B and two patients (7.7%) in group C] had hemorrhage during or subsequent to treatment. Sixteen patients (six in group A, eight in group B and two in group C) succumbed during the hospital admission period. The mortality rate was 13.3% (8.8% for group A, 30.7% for group B and 7.7% for group C) in the acute phase. A favorable outcome (modified Rankin Scale score, 0-2) in the first three months after stroke was only observed in 43.3% of patients (44.1% in group A, 46.7% in group B and 36.4% in group C). The mean Barthel index was 72.3 in group A, 84.4 in group B and 56.8 in group C (total patient population, 71.0). The results of the present study have shown that stroke treatment with tirofiban is safe in AIS. A large randomized controlled trial in the future is required to decrease the incidence of the minor bleeding complications associated with tirofiban therapy.

Progressive Ischemic Stroke: Clinical Features and Evaluation of Short-and Long- Term Tirofiban Therapy

“…The progression occured on average 27.85 hours (6-72 hours) after the onset of stroke symptoms. The average NIHSS score at hour 1 of admission was 7.14 (2-6); the score at the time of progression occurence was 10.21 (5-21) with an average NIHSS increase of 3.07 (2-11); at 24 hours after administration of tirofiban, the score was 9.79 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and on discharge the score was 9.46 (1-18) (Figure 1). In the evaluation of the patient groups in terms of stroke subtypes, the NIHSS score was found to be highest in the cardioembolic stroke group and lowest in the small vessel disease group.…”

“…In an another study which compared Tirofiban monotherapy, trombolytic treatment and interventional treatment, bleeding complication was not observed in tirofiban group but recanalization rate was found lowly (25%) compared to other groups (12).…”

“…The criteria for inclusion in the study were: presence of minor or medium-degree stroke on admission [with National Institute of Health Stroke Scale (NIHSS) score of [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], final diagnosis of PIS, age range of 18-80, contraindication for thrombolytic therapy, tirofiban use for therapy, and reachable control data at the end of the 3. month. The criteria for exclusion from the study were history of cerebral or extracerebral hemorrhage, known intracranial disease (such as arteriovenous malformation, neoplasm, aneurysm), liver disease, thrombocytopenia (platelet number <100.000), platelet dysfunction, major trauma, major surgery in the last 3 months, and past stroke; coagulopathy [prothrombin time (PT) >1.3 times of the normal and international normalized ratio (INR) >1.3].…”

Recanalisation therapy in patients with acute ischaemic stroke caused by large artery occlusion: choice of therapeutic strategy according to underlying aetiological mechanism?

“…Platelet function returned in 2 hours when stopped, 46 which might make tirofiban a more desirable glycoprotein IIb/IIIa receptor inhibitors in AIS. Acceptable safety outcomes and more favourable function outcomes have been reported in small case series of AIS treated with tirofiban alone, 47 tirofiban in combination with intravenous or IA thrombolysis 47–49 and tirofiban in combination with bridging therapy, 50 51 respectively. In a prospective, randomised, placebo-controlled, open-label treatment phase II trial, tirofiban did not increase the risk of cerebral haemorrhagic transformation (HT) and parenchymal haemorrhage but may decrease the mortality rate at 5 months.…”

Platelets in Thrombo-Inflammation: Concepts, Mechanisms, and Therapeutic Strategies for Ischemic Stroke

“…53 Nonetheless, especially tirofiban is discussed controversially regarding its use in AIS patients, since some studies showed the safety and efficacy of this drug in patients with rescue stenting, using tirofiban alone or together with standard thrombolytic therapy. 54,55 In conclusion, despite the high potency of anti-GPIIb/IIIa treatment in patients with AMI and some promising clinical studies using tirofiban in a certain subgroup of ischemic stroke patients, this receptor has to be considered as unreliable, yet druggable target in the therapy of ischemic stroke (►Table 1). Very importantly, these data provide strong evidence that platelet aggregation may not be of major significance for thrombo-inflammation and immune cell recruitment in the infarcted brain, implicating that other platelet-dependent mechanisms are responsible for the pathological progress of I/RI in AIS.…”