Abstract
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.
Highlights
A number of randomized clinical trials have shown the benefit of mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS) that is due to large-vessel occlusion (LVO) [1, 2]
Coagulation function was assessed by preoperative and postoperative coagulation indicators, including prothrombin time (PT), activated partial thromboplastin time (APTT), and platelet count, which were similar between the two groups
The main findings of our study are as follows: [1] more patients in the tirofiban group had favorable clinical outcomes after Propensity score matching (PSM) matching, and intracranial hemorrhage (ICH) and mortality did not differ between the two groups; [2] multivariate regression analysis demonstrated that tirofiban was positively associated with favorable clinical outcomes but not with ICH, mortality, or other safety indicators; and [3] tirofiban was associated with increasing favorable clinical outcomes in patients with anterior circulation stroke (ACS) but not in patients with posterior circulation stroke (PCS)
Summary
A number of randomized clinical trials have shown the benefit of mechanical thrombectomy (MT) in the treatment of acute ischemic stroke (AIS) that is due to large-vessel occlusion (LVO) [1, 2]. This endovascular recanalization approach may lead to endothelial injury, plaque rupture, and subsequent platelet activation, leading to early re-occlusion and poor prognosis. A series of follow-up studies have reported a number of clinically valuable findings about the tirofiban regimen following MT, including the specific dose [4], injection method [5], and patient selection according to etiology [6]. There are some studies about the benefit of MT in PCS patients and the administration of tirofiban following MT [9, 10], but there are few studies exploring tirofiban in patients with PCS
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