The efficacy and safety of tirofiban versus oral antiplatelet drug therapy in acute ischemic stroke patients with early neurological deterioration

Abstract

Purpose Early neurological deterioration (END) is common after acute ischemic stroke (AIS) and associated with poor outcome. The antithrombotic strategy for END is still a pending question without specific evidence-based recommendation. Whether traditional oral antiplatelet (AP) drug or intravenous tirofiban is more beneficial for END needs further research. Our study aimed to compare the efficacy and safety of tirofiban with oral AP drugs in patients who experienced END without thrombolysis or mechanical thrombectomy and evaluate which stratified population gained the most benefit from tirofiban. Methods A total of 222 AIS patients with END from January 2016 to June 2021 were retrospectively enrolled and divided into the oral AP group and tirofiban group. The functional outcome was assessed with the National Institute of Health Stroke Scale (NIHSS) at discharge and modified Rankin scale (mRS) at 90 days. Results Compared with the oral AP group, more patients in the tirofiban group achieved NIHSS improvement by ≥2 points at discharge (61.7% vs. 25.2%, p = 0.000) and a favorable outcome (mRS 0-2) at 90 days (60.7% vs. 42.6%, p = 0.007). No moderate or severe hemorrhage occurred, and mild hemorrhage was comparable in both groups (p = 0.199). Logistic regression demonstrated that tirofiban was associated with NIHSS improvement at discharge [adjusted odds ratio (OR) 4.930; 95% confidence interval (CI) 2.731-8.898] and 90-day favorable outcome (adjusted OR 2.242; 95% CI 1.080-4.653). Subgroup analysis showed that compared with oral AP, tirofiban improved NIHSS scores at discharge in all subgroups, and improved 90-day mRS in the subgroups of large-artery atherosclerosis (p = 0.004), age ≤75 years (p = 0.03), and NIHSS 4-7 (p = 0.001). Conclusions Based on our results, tirofiban monotherapy could be an alternative to traditional oral AP strategy for the treatment of END.