The Safety of Intra-arterial Tirofiban during Endovascular Therapy after Intravenous Thrombolysis

Abstract

BACKGROUND AND PURPOSE:The safety and efficacy of tirofiban during endovascular therapy in patients undergoing intravenous thrombolysis with recombinant IV tPA remain unclear. This study aimed to investigate the safety and efficacy of intra-arterial tirofiban use during endovascular therapy in patients treated with IV tPA. MATERIALS AND METHODS:Using a multicenter registry, we enrolled patients with acute ischemic stroke who underwent endovascular therapy. Safety outcomes included postprocedural parenchymal hematoma type 2 and/or thick subarachnoid hemorrhage, intraventricular hemorrhage, and 3-month mortality. Efficacy outcomes included the successful reperfusion rate, postprocedural reocclusion, and good outcomes at 3 months (mRS scores of 0-2). The tirofiban effect on the outcomes was evaluated using a multivariable analysis while adjusting for potential confounders.RESULTS: Among enrolled patients, we identified 314 patients with stroke (279 and 35 patients in the no tirofiban and tirofiban groups, respectively) due to an intracranial artery occlusion who underwent endovascular therapy with intravenous thrombolysis. A multivariable analysis revealed no association of intra-arterial tirofiban with postprocedural parenchymal hematoma type and/or thick subarachnoid hemorrhage (adjusted OR, 1.07; 95% CI, 0.20-4.10; P ¼ .918), intraventricular hemorrhage (adjusted OR, 0.43; 95% CI, 0.02-2.85; P ¼ .467), and 3-month mortality (adjusted OR, 0.38; 95% CI, 0.04-1.87; P ¼ .299). Intra-arterial tirofiban was not associated with good outcome (adjusted OR, 2.22; 95% CI, 0.89 -6.12; P ¼ .099).CONCLUSIONS: Using intra-arterial tirofiban during endovascular therapy after IV tPA could be safe.ABBREVIATIONS: aOR ¼ adjusted OR; EVT ¼ endovascular therapy; IA ¼ intra-arterial; ICAS-O ¼ intracranial atherosclerotic stenosis-related occlusion; IVT ¼ intravenous thrombolysis; LVO ¼ large-vessel occlusion; mTICI ¼ modified TICI

Safety and Efficacy of Tirofiban During Intravenous Thrombolysis Bridging to Mechanical Thrombectomy for Acute Ischemic Stroke Patients: A Meta-Analysis

“…A search from databases identified 329 papers (Pubmed:40, EMBASE: 83, The Cochrane Library: 25, Web of Science: 105, CNKI 46, Wanfang: 30), of which 62 duplicates were excluded, the titles and abstracts of the shortlisted papers were reviewed and another 247 papers, and the remaining 20 papers were read in full-text detail to determine whether they met the inclusion/exclusion criteria, and ultimately, 7 eligible (16)(17)(18)(19)(20)(21)(22) papers were included in this meta-analysis (shown in Figure 1).…”

“…One thousand one hundred and seventy six patients from seven (16)(17)(18)(19)(20)(21)(22) studies [one (22) randomized controlled trial and six (16)(17)(18)(19)(20)(21) observational studies] were included in the final analysis, of which 340 patients (28.9%) were treated with tirofiban. Basic characteristics of the included studies are shown in Table 1.…”

“…A total of seven (16)(17)(18)(19)(20)(21)(22) studies were included, of which one (22) study was an RCT and six studies (16)(17)(18)(19)(20)(21) were observational studies, and the quality of randomized controlled trials was evaluated using RoB 2.0 tool (Supplementary Figure 1), and observational studies were evaluated using NOS quality (Supplementary Table 1); in conclusion, the quality scores of the included literature were high, describing the selection of study populations and comparability between groups.…”

“…In a total of 5 (16)(17)(18)(19)(20) 4) in the tirofiban and non-tirofiban groups. A pooled analysis of six studies (16-21) evaluating ICH showed no statistically significant difference in the incidence of ICH between the tirofiban and non-tirofiban groups (OR = 0.83, 95% Cl [0.55, 1.24], p = 0.36; shown in Figure 5), with heterogeneity (I 2 = 10%, p = 0.35).…”

Association of Intravenous Thrombolysis with Delayed Reperfusion After Incomplete Mechanical Thrombectomy

“…Accurate prediction of perfusion outcome may help in the selection of patients for e.g. intra-arterial thrombolysis [35,36] administration of antithrombotics [37,38] or secondary distal MT [39,40]. While potentially beneficial, all of these treatments also harbor a risk of harm, warranting a careful patient selection.…”