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

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

doi:10.1155/2020/5656173

Abstract

Introduction Limited comparative studies have reported the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients after mechanical thrombectomy (MT). Additionally, the available studies are inconsistent with each other, which makes application of tirofiban unclear in neuro-intervention. Here, we performed a comparative retrospective study to investigate whether tirofiban combined with MT improves short- and long-term prognosis in AIS patients and whether its use is associated with complications. Method Retrospective data were collected for AIS patients admitted between January 2013 and January 2019 at three stroke centers. According to whether tirofiban was used during the operation, patients were divided into tirofiban group and control group. Multivariate and COX regression analyses were performed to determine the association of tirofiban treatment with safety and efficiency in subjects treated with MT. Result A total of 174 patients were analyzed, of whom 89 (51.1%) were treated with tirofiban. There were no differences in the incidence of symptomatic intracerebral hemorrhage (10.2% vs. 10.6%, p=0.918), parenchymal hemorrhage type 2 (18.0% vs. 16.5%, p=0.793), and reocclusion at 24 h (3.4% vs. 10.6%, p=0.060) between the tirofiban group and control group. Multivariate regression showed that tirofiban was not associated with intracerebral hemorrhage, early neurological deterioration, neurological improvement at 7 days, functional independence at 3-month and 9-month follow-up, or death at 9-month follow-up (adjusted p > 0.05 for all). However, AIS patients treated with MT + tirofiban showed a trend towards acquiring faster functional independence, with a median time to acquire functional independence of 4.0 months compared with 6.5 months in the control group (risk ratio = 1.49, 95% confidence interval 0.98–2.27; long rank p=0.066). Conclusion Tirofiban may help AIS patients given MT to gain functional independence faster, without increasing the risk of complications.

Highlights

Limited comparative studies have reported the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients after mechanical thrombectomy (MT)
There were a longer OTP time (345 vs. 258.5 min), a higher percentage of balloon angioplasty (30.3% vs. 7.1%), permanent stenting (23.6% vs. 8.2%), operative antiplatelet (84.3% vs. 57.6%), a more modified treatment in cerebral infarction (mTICI) ≥2b (76.4% vs. 56.5%), sedation (32.6% vs. 16.5%), and a lower rate of anticoagulation (19.1% vs. 44.7%) than that in the control group (p < 0.05, each). e other factors showed no differences in two groups (p > 0.05, each)
After adjusting for atrial fibrillation and National Institutes of Health Stroke Scale (NIHSS) on admission, AIS patients treated with MT + tirofiban showed a trend for acquiring faster functional independence

Summary

Introduction

Limited comparative studies have reported the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients after mechanical thrombectomy (MT). We performed a comparative retrospective study to investigate whether tirofiban combined with MT improves short- and long-term prognosis in AIS patients and whether its use is associated with complications. Multivariate regression showed that tirofiban was not associated with intracerebral hemorrhage, early neurological deterioration, neurological improvement at 7 days, functional independence at 3-month and 9-month follow-up, or death at 9-month follow-up (adjusted p > 0.05 for all). AIS patients treated with MT + tirofiban showed a trend towards acquiring faster functional independence, with a median time to acquire functional independence of 4.0 months compared with 6.5 months in the control group (risk ratio 1.49, 95% confidence interval 0.98–2.27; long rank p 0.066). Tirofiban may be more effective than other existing antiplatelet agents

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Results

Conclusion