The Safety and Efficiency of Tirofiban in Acute Ischemic Stroke Patients Treated with Mechanical Thrombectomy: A Multicenter Retrospective Cohort Study

Zhao, Lili; Jian, Yating; Li, Tao; Wang, Heying; Zhang, Lei; Sun, Min; Li, Ye; Zhang, Yiheng; Dang, Meijuan; Wang, Huqing; Sun, Hong; Zhang, Ru; Zhang, Hongxing; Jia, Yi; Luo, Gaoxing; Zhang, Guilian

doi:10.1155/2020/5656173

Cited by 13 publications

(10 citation statements)

References 32 publications

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“…Most studies have demonstrated that tirofiban has great clinical application prospects in MT, and tirofiban has proved to be an independent predictor of favorable outcomes (17)(18)(19). A multicenter retrospective cohort confirmed that the safety of tirofiban was not associated with ICH or mortality (20). In contrast, other studies have shown that tirofiban does not improve clinical outcomes (21) and may be associated with an increased risk of fatal ICH (22,23).…”

Section: Discussionmentioning

confidence: 95%

Can Tirofiban Improve the Outcome of Patients With Acute Ischemic Stroke: A Propensity Score Matching Analysis

Cai

et al. 2021

Front. Neurol.

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Objective: To evaluate the efficacy and safety of tirofiban for patients with acute ischemic stroke (AIS), especially posterior circulation stroke (PCS).Methods: We enrolled consecutive patients with AIS who suffered large artery occlusion (LAO) and underwent mechanical thrombectomy (MT) between January 2016 and May 2020. Patients were divided into two groups according to whether tirofiban was used during MT. The primary efficacy outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0–2 at 3 months. The safety outcomes were the rate of mortality at 3 months and the presence of intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH). Cohorts were balanced using 1:1 propensity score matching (PSM). Subgroup analysis was further performed to compare the efficacy and safety of tirofiban between the anterior circulation stroke (ACS) and PCS groups.Results: A total of 292 patients were eligible for this study and divided into the tirofiban group (n = 51) and the no-tirofiban group (n = 241). In the propensity-score-matched cohort, the tirofiban group had a higher rate of favorable outcomes than the no-tirofiban group (49.0 vs. 25.5%, p = 0.014), and the mortality at 3 months showed a greater downward trend in the tirofiban group than the no-tirofiban group (15.6 vs. 33.3% p = 0.064). The risk of sICH and ICH was the same between the tirofiban and control groups (17.6 vs. 27.4% p = 0.236, 31.3 vs. 45.1% p = 0.154, respectively). Tirofiban use was predictive of favorable outcomes [adjusted odds ratio (aOR) = 2.87, 95% confidence interval (CI) 1.52–6.44, p = 0.043] after multiple logistic regression analysis. Subgroup analysis revealed that tirofiban use was significantly associated with favorable outcomes in ACS (aOR = 3.66, 95% CI 1.24–5.22, p = 0.019) but not in PCS (aOR = 1.12, 95% CI 0.47–7.52, p = 0.570).Conclusion: We demonstrated that tirofiban may be associated with improving favorable outcome for the AIS patients who underwent MT, without increasing ICH or sICH. Furthermore, our results indicated that for PCS patients tirofiban may not be associated with favorable outcome, and more comprehensive randomized controlled trials are needed to confirm this finding.

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Section: Discussionmentioning

confidence: 95%

Can Tirofiban Improve the Outcome of Patients With Acute Ischemic Stroke: A Propensity Score Matching Analysis

Cai

et al. 2021

Front. Neurol.

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“…Machine learning is a speci c form of arti cial intelligence that uses algorithms to analyze and learn from data to make predictions and decisions about actual events. e classic algorithms of machine learning include logistic regression, decision tree, support vector machine, arti cial neural network, and convolutional neural network [15]. Machine learning is a multidisciplinary interdisciplinary major, covering knowledge of probability theory, statistics, approximate theory, and complex algorithms.…”

Section: Application Of Machine Learning Model In Prediction Aftermentioning

confidence: 99%

Meta-Analysis of Predictive Role of Early Neurological Deterioration after Intravenous Thrombolysis

Jiang

Zuo

Chen

et al. 2022

Emergency Medicine International

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With the popularization of intravenous thrombolysis, more and more people use intravenous thrombolysis to treat related diseases, but problems also arise. There are still a considerable number of patients with early disease after thrombolytic therapy not only not significantly improving, but also progressing, that is, early neurological deterioration (END). In view of this problem, the prediction of END after intravenous thrombolysis becomes very important. With the development of medical technology, research on the prediction of END after intravenous thrombolysis has gradually been carried out. Effective prediction is of great significance for the prevention and treatment of END after intravenous thrombolysis. This article aimed to carry out a meta-analysis of the predictive role of END after intravenous thrombolysis. Through an informed analysis of all studies of this type in this field, this article determines a method for predicting END after intravenous thrombolysis. The actual effect of its role is revealed in this paper, and its purpose is to promote the development of this field. This article addresses the same type of study on the predictive role of neurological deterioration after intravenous thrombolysis. The article performs test and meta-analysis of its role by conditionally searching for literature studies. It is explained using the relevant theoretical formulas. The analysis results show that the prediction of END after intravenous thrombolysis in this paper can effectively help make a preliminary judgment on the possible later neurological deterioration. Although there is an error between the predicted curve and the actual curve, the difference between the two is between 1% and 5%. It can basically effectively predict the occurrence of END. Therefore, the prediction of END after intravenous thrombolysis has a very large preventive effect on the END after intravenous thrombolysis.

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“…Data on the occurrence of 3-month mRS 0-2 score were available in 14 studies [16,17,[19][20][21][22][23][24][25][26][27][28][29][30] involving a total of 3,251 patients (1,169 with tirofiban and 2,082 without tirofiban). The incidence of 3-month mRS 0-2 score of the tirofiban group was higher than that of the control group (OR = 1.27, 95% Cl [1.09, 1.48], p = 0.002; shown in Fig.…”

Section: The Efficacy Of Tirofibanmentioning

confidence: 99%

“…retriever A bolus at a rate of 1 mL/min (dose range of 0.25-0.5 mg) Ho J. Yi et al[25] retriever A bolus at a rate of 0.05 mg/min (dose range of 0.25-1.0 mg) followed by a maintenance dose of 0.05 μg/kg/min intravenously for 24 h Lars Kellert et al[19] a rate of 0.4 μg/kg/min over 30 min, followed by a continuous infusion of 0.1 μg/kg/min for 48 h Lili Zhao et al[30] 5 μg/kg (dose range of 0.25-0.5 mg) followed by continuous infusion of 0.1 μg/kg/min for 24arterial bolus (0.25-1 mg) followed by continuous intravenous infusion of 0.1 μg/kg/min for 24 a rate of 1 mL/min (dose range of 0.25-1.0 mg) Tao Quan et al[23] arterial bolus (the dose ranged from 0.25 to 0.5 mg) followed by continuous intravenous infusion at a rate of 0.2-0.25 mg/h for 12-24 h Tongya Yu et al [20] Observational 26 28 70.27/67.79 12/14 15/13 Stent retriever A intra-arterial bolus at a rate of 1 mL/min (the dose ranged from 0.2 to 0…”

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confidence: 99%

The Application of Tirofiban in the Endovascular Treatment of Acute Ischemic Stroke: A Meta-Analysis

Tang

Yang

2021

Cerebrovasc Dis

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Objective: The purpose of this meta-analysis is to evaluate the safety and efficacy of tirofiban during endovascular treatment (EVT) for acute ischemic stroke (AIS) patients. Methods: We systematically searched PubMed, Embase, Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) databases for randomized controlled trials and cohort studies (published before May 1, 2020; no language restrictions) comparing tirofiban administration to blank control during EVT in patients with AIS. Our primary end points were the 3-month functional outcome, recanalization rate, symptomatic intracerebral hemorrhage, and 3-month mortality. Results: The incidence of 3-month modified Rankin Scale (mRS) 0–2 score of the tirofiban group was higher than that of the control group (odds ratio [OR] = 1.27, 95% CI [1.09, 1.48], p = 0.002) with heterogeneity (I2 = 34%, p = 0.11). Data pooled from the 6 studies describing the details of retriever stent in EVT revealed that tirofiban was associated with higher incidence of 3-month mRS 0–2 score (OR = 1.48, 95% CI [1.11, 1.96], p = 0.007). The recanalization rate was higher in the tirofiban group compared to the control group (OR = 1.66, 95% CI [1.16, 2.39], p = 0.006). There were no statistically significant differences in the incidence of symptomatic intracranial hemorrhage (OR = 0.97, 95% CI [0.73, 1.31], p = 0.86) and intracranial hemorrhage (OR = 1.08, 95% CI [0.59, 1.97], p = 0.80) between tirofiban and non-tirofiban group. Besides, the tirofiban administration was associated with lower mortality (OR = 0.75, 95% CI [0.62, 0.91], p = 0.003). Conclusions: The application of tirofiban in EVT of AIS may improve functional outcomes and reduce mortality at 3 months. Besides, tirofiban does not seem to increase the risk of symptomatic intracranial hemorrhage and intracranial hemorrhage, either in the anterior or posterior circulation stroke.

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The Safety and Efficiency of Tirofiban in Acute Ischemic Stroke Patients Treated with Mechanical Thrombectomy: A Multicenter Retrospective Cohort Study

Cited by 13 publications

References 32 publications

Can Tirofiban Improve the Outcome of Patients With Acute Ischemic Stroke: A Propensity Score Matching Analysis

Can Tirofiban Improve the Outcome of Patients With Acute Ischemic Stroke: A Propensity Score Matching Analysis

Meta-Analysis of Predictive Role of Early Neurological Deterioration after Intravenous Thrombolysis

The Application of Tirofiban in the Endovascular Treatment of Acute Ischemic Stroke: A Meta-Analysis

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