Safety Of Tirofiban Research Articles

The Effectiveness and Safety of Adjuvant Therapy with t-PA in Acute Ischemic Stroke: A Systematic Review and Network Meta-Analysis

Introduction: Acute ischemic stroke (AIS) is a leading cause of disability and death worldwide. While tissue plasminogen activator (t-PA) remains a cornerstone of treatment, its efficacy is limited by risks such as intracranial hemorrhage (ICH). The current systematic review and network meta-analysis aimed to evaluate the effectiveness and safety of adjuvant antithrombotic therapies combined with t-PA in AIS. Methods: A systematic search of multiple databases was conducted to identify prospective clinical trials that compared the efficacy and safety of tirofiban, eptifibatide, and argatroban in adjunctive therapies to t-PA in AIS. The primary outcomes included functional recovery, measured by a modified Rankin Scale (mRS) score of 0–1 at 90 days, and safety outcomes such as ICH and mortality. Results: Eight clinical trials involving 2,074 patients were included. Tirofiban plus t-PA significantly improved functional recovery at 90 days compared to t-PA alone (Odds Ratio [OR] 2.23, 95% Confidence Interval [CI]: 1.08–4.60). In contrast, neither argatroban nor eptifibatide significantly improved functional recovery, with ORs of 0.92 (95% CI: 0.48–1.78) and 0.63 (95% CI: 0.32–1.23), respectively. Argatroban was associated with an increased risk of mortality (OR 3.28, 95% CI: 1.52–7.07), whereas tirofiban and eptifibatide did not significantly increase mortality risk. None of the studies showed a statistically significant difference in the risk of ICH. Conclusion: Tirofiban, as an adjunct to t-PA, demonstrated superior efficacy and safety, suggesting its viability in AIS management. Meanwhile, the association of argatroban with increased ICH and mortality raises concerns about its use.

Efficacy and safety of tirofiban in patients with acute ischemic stroke treated with endovascular thrombectomy: A frequentist and Bayesian meta-analysis

BackgroundTirofiban is an antiplatelet treatment approved for acute coronary syndrome, but it has not been rigorously evaluated for efficacy and safety in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). MethodsElectronic databases were systematically searched for studies conducted from January 1, 2015, to July 31, 2021, that evaluated tirofiban administration for patients with AIS treated with EVT in comparison with control. Risk ratios (RRs) and confidence intervals (CIs) were estimated for favorable functional outcomes (FFOs), mortality, and symptomatic intracranial hemorrhage (SICH), each 90 days after AIS. Bayesian hierarchical modeling was performed to obtain posterior RR and its 95% highest posterior density (HPD) for validation. ResultsCompared with controls, tirofiban users exhibited increased FFOs (RR, 1.18; 95% CI, 1.08–1.30), decreased mortality (RR, 0.77; 95% CI, 0.64–0.92), and no difference in SICH (RR, 0.97; 95% CI, 0.77–1.23). Tirofiban users in the postbolus infusion subgroup exhibited increased FFOs (RR, 1.20; 95% CI, 1.07–1.35), decreased mortality (RR, 0.71; 95% CI, 0.58–0.88), and no increase in SICH (RR, 0.97; 95% CI, 0.72–1.29). The bolus-only subgroup showed no differences in FFO, mortality, or SICH between the tirofiban and control groups. Consistent results were obtained for posterior density of FFO (posterior RR, 1.20; 95% HPD, 1.06–1.34), mortality (posterior RR, 0.77; 95% HPD, 0.63–0.92), and SICH (posterior RR, 0.98; 95% HPD, 0.71–1.26). ConclusionFor patients with AIS treated with EVT, tirofiban improved FFOs, decreased mortality, and did not increase SICH compared with controls; postbolus infusion for administering tirofiban was more favored than the bolus-only regimen.

Abstract TMP6: Association Of Tirofiban With Outcomes After Thrombectomy In Stroke Due To Atherosclerosis: An Exploratory Analysis Of The RESCUE BT Placebo-controlled Randomized Trial

Background: The efficacy and safety of tirofiban, as an adjuvant medication of endovascular therapy (EVT), in patients with large vessel occlusion due to atherosclerotic thrombosis was still unclear. Methods: The Endovascular Treatment With versus Without Tirofiban in Stroke (RESCUE BT) trial was a randomized, double-blinded, placebo-controlled trial that was performed at 55 centers in China from October 10, 2018 to October 31, 2021. This was a post hoc exploratory analysis of the RESCUE BT trial and 435 patients were included in the intention-to-treat analysis. The primary outcome was the proportion of functional independence (defined as modified Rankin Scale 0-2) at 90 days. We estimated the efficacy and safety of EVT plus placebo versus EVT plus tirofiban using binary logistic regression analysis. A causal mediation analysis was also performed to assess the potential mediators of tirofiban on functional outcome. Results: This study included 435 patients, including 197 patients assigned to the tirofiban group and 238 patients assigned to the placebo group. The median age was 65 [IQR, 56-72] years, and 311 (71.5%) patients were men. Tirofiban was associated with higher rates of functional independence at 90 days compared with the placebo (adjusted odds ratio with 95% CI, 1.68 [1.11–2.56], P = 0.014). There was no significant difference in mortality and symptomatic intracranial hemorrhage between the two groups, thought the rate of intracranial hemorrhage was numerically higher in the tirofiban group (29.1% versus 23.2%, P = 0.165). Tirofiban was also associated with fewer number of thrombectomy passes (beta, -0.48; 95% CI, -0.62 to -0.34; P < 0.001). Treatment-reduced passes explains 20.0% (95% CI, 4-76) of the beneficial effect of tirofiban on functional independence. Conclusion: Tirofiban plus EVT might be an effective and well-tolerated option for patients with anterior large vessel occlusion due to atherosclerosis. These findings are needed to be confirmed in future trials.

Abstract WP153: Tirofiban Increase Symptomatic Intracranial Hemorrhage After Endovascular Therapy In Cardio-embolized Stroke Patients: Insight From Rescue Bt Trial

Introduction: Efficacy and safety of tirofiban in endovascular therapy among cardio-embolized ischemic stroke patients remains controversial. We aimed to assess effects of tirofiban before endovascular therapy in cardio-embolized stroke patients. Methods: This is a post hoc analysis of Endovascular Treatment With vs Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) trial. Before endovascular therapy, participants were randomized to tirofiban or placebo group in ratio of 1:1. Tirofiban was administrated as a bolus dose of 10 ug/kg, followed by continuous infusion of 0.15 ug/kg /min for up to 24-hour. We collected cardio-embolized stroke patients according to Trial of Org 10172 in Acute Stroke Treatment classification. The efficacy outcome was global disability at 90-day assed by modified Rankin Scale (mRS). The primary safety outcome was symptomatic intracranial hemorrhage (sICH) assessed by Heidelberg bleeding classification within 48-hour. Secondary safety outcome was any radiologic intracranial hemorrhage and death at 90-day. Results: 406 cardio-embolized stroke patients were collected. Tirofiban did not correlated to favorable shift to lower 90-day mRS (adjusted odds ratio [aOR], 0.91; 95% CI, 0.64-1.3; P = 0.617). However, tirofiban subgroup had a significantly higher risk of sICH within 48-hour (aOR, 3.26; 95% CI, 1.4-7.57; P = 0.006) compared with placebo group. The aOR was 1.44 (95% CI, 0.94-2.19; P = 0.094) for any intracranial hemorrhage and 1.48 (95% CI, 0.88-2.52; P = 0.143) for death at 90-day. Conclusions: Tirofiban increased symptomatic intracranial hemorrhage after endovascular therapy in cardio-embolized stroke patients. Figure 1 . Outcomes of endovascular therapy in cardio-embolic stroke participants in tirofiban vs placebo group.

Efficacy and safety of tirofiban in patients with acute ischemic stroke without large-vessel occlusion and not receiving intravenous thrombolysis: A randomized controlled open-label trial

ObjectiveTo investigate the effectiveness and safety of tirofiban in patients with acute ischemic stroke (AIS) without large-vessel occlusions and not receiving intravenous thrombolysis. MethodsOverall, 267 cases were included in the study (134 cases in tirofiban group; 133 cases in control group). After admission, patients in the tirofiban group were administered tirofiban for at least 72 h, and aspirin 100 mg and hydroclopidogrel 75 mg were administered 4 h before discontinuation of tirofiban administration. All patients were followed for 3 months, and the National Institutes of Health Stroke Scale (NIHSS) scores on admission, 24 h, and 7 d after treatment, intracerebral hemorrhage transformation within 48 h from stroke onset, and bleeding were assessed. ResultsThere was no significant difference between both groups in the incidence of non-symptomatic and symptomatic intracranial hemorrhage (sICH), extracranial hemorrhage events, and thrombocytopenia (p > 0.05). There was a significant different between the NIHSS scores at baseline and 7 d after treatment in the tirofiban group (p = 0.043). At 90 d after treatment, the proportion of patients with a good prognosis in the tirofiban group (modified Rankin Scale [mRS] = 0, 1) was higher than that in the control group (p = 0.021). There was no difference in the proportion of patients with a mRS score of 0–2 between the two groups (p > 0.05). ConclusionAdministration of tirofiban for >72 h (72 h–108 h) is safe and can improve the long-term (90 d) prognosis of patients with AIS without large-vessel occlusions and not receiving intravenous thrombolysis.

Safety and efficacy of low-dose and long-course tirofiban in large hemispheric infarction.

BackgroundThe clinical efficacy and safety of tirofiban in the treatment of large hemispheric infarction (LHI) remain controversial.MethodsThis study prospectively enrolled patients with acute LHI who were admitted to Putuo Hospital affiliated with Shanghai University of Traditional Chinese Medicine from June 2021 to December 2021. The patients were randomly assigned to the tirofiban group [3–4 μg/(kg·h)] or control group (clopidogrel 75 mg/d).ResultsA total of 71 patients with acute LHI were selected: 36 in the tirofiban group and 35 in the control group. The reduction of the NIHSS score in the tirofiban group was 2.92 ± 9.31 at discharge, and that of the control group was −3.23 ± 12.06 (p = 0.021, OR, 0.006; 95% CI, 0.004–0.008). Six patients (16.7%) in tirofiban group and 14 patients (40%) in control group died during hospitalization (p = 0.029, OR, 0.300; 95% CI, 0.099–0.908). There was significant difference in Modified Rankin Scale (mRS) 5–6 scores at 90 days between the two groups (p = 0.023, OR, 0.327; 95% CI, 0.124–0.867). However, there was no significant difference in mRS 0–1 (p = 0.321, OR, 0.972; 95% CI, 0.920–1.027), mRS 2 (p = 0.572, OR, 2.00; 95% CI, 0.173–23.109), mRS 3 (p = 0.225, OR, 2.214; 95% CI, 0.601–8.161), or mRS 4(p = 0.284, OR, 1.859; 95% CI, 0.593–5.825) scores between the two groups. There was no difference in symptomatic intracranial hemorrhage (p = 0.29, OR, 0.305; 95% CI, 0.030–3.081), asymptomatic intracranial hemorrhage (p = 0.123, OR, 0.284; 95% CI, 0.053–1.518). There was a significant difference in systemic bleeding events during hospitalization (p = 0.044, OR, 0.309; 95% CI, 0.096–1.000).ConclusionsLow-dose and long-course tirofiban treatment may significantly improve the early neurological function and reduce the in-hospital mortality in LHI patients. Meanwhile, tirofiban does not increase the risk of any type of bleeding events.

Effectiveness of Tirofiban in Patients Undergoing Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction: A Meta-Analysis of Randomized Clinical Trials

Whether or whether or not tirofiban is beneficial within side the quick time period for sufferers with STEMI who go through PCI is debatable. A meta-analysis validated the short-term efficacy and safety of tirofiban in patients with ST-phase elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Comparing STEMI patients undergoing PCI with and without tirofiban. We found all relevant randomised controlled trials by searching scientific databases and websites. This fixed-results model computed RR and 95% CI. 10 RCTs included 5008 people. After 30 days, death from any cause (RR 0.79, CI 0.55-1.12, P=0.18), major bleeding (1.37, 0.93-2.03, P=0.11), or transfusion (1.23, 0.94-1.61, P=0.13) were no longer impacted. Minor bleeding (1.29, 1.02-1.63, P=0.04), thrombocytopenia (2.04, 1.40-2.97, P=0.0002), and 6-month all-purpose mortality (0.57, 0.36-0.90, P=0.02) showed statistically significant differences. Repeat revascularization (0.58, 0.43-0.78, P=0.0004) and myocardial infarction (0.55, 0.33-0.92, P=0.02) also differed. Mild bleeding and thrombocytopenia are more common with tirofiban, although reinfarction, revascularization, and death after 6 months are decreased.

Effect of tirofiban in treating patients with progressive ischemic stroke.

Our aim is to investigate the efficacy and safety of tirofiban in the treatment of patients experiencing progressive ischemic stroke (PIS). A retrospective analysis was performed on the clinical data of 150 patients with ischemic stroke admitted to our hospital from May 2018 to December 2019. All the patients were divided into two groups according to different treatment methods. In Control group, conventional comprehensive treatment and antiplatelet therapy with aspirin + clopidogrel were conducted, while tirofiban was administered in Tirofiban group in addition to the treatments in Control group. Neurological deficits were scored by means of the National Institutes of Health Stroke Scale (NIHSS) at the time of progression and 30 d after treatment, and the modified Rankin Scale (mRS) and Activity of Daily Living (ADL) scale were employed to assess prognosis at 90 d after treatment. Thereafter, the platelet aggregation rate, platelet adhesion rate, plateletcrit (PCT), platelet distribution width (PDW), and platelet inhibition rate were measured before and after treatment. Finally, the patients were followed up, and the occurrence of hemorrhage events during treatment and within 90 d after discharge was recorded. After treatment, all the patients had significantly lower NIHSS and mRS scores and a dramatically higher Barthel index (BI) than those before treatment (p<0.001). At 90 d after treatment, Tirofiban group exhibited significantly higher BI (p<0.001) and lower mRS score than Control group (p=0.011). In addition, at 14 d after treatment, the clinical efficacy was assessed for all the patients. It was found that the overall response rate in Tirofiban group was substantially higher than that in Control group [82.7% (62/75) vs. 64.0% (48/75), p=0.009]. At 7 d after treatment, the PCT and adenosine diphosphate (ADP) platelet inhibition rate in Tirofiban group were markedly higher than those in Control group (p=0.006, p<0.001), and Tirofiban group had remarkably lower measured values of platelet aggregation rate, platelet adhesion rate and PDW than Control group (p=0.007, p=0.021, p<0.001). After treatment, the levels of serum IL-6 and hs-CRP declined notably in the two groups of patients, and the differences in their levels at 2 and 14 d after treatment between the two groups were statistically significant (p<0.05). During treatment and within 90 d after discharge, both groups of patients had no cerebral hemorrhage, gastrointestinal hemorrhage, and severe hemorrhage adverse events requiring blood transfusion, but they experienced subcutaneous ecchymosis, epistaxis, gingival hemorrhage, and hemorrhage around the infarct, which were improved after symptomatic treatment. Moreover, the occurrence rate of hemorrhage in Tirofiban group was higher than that in Control group, showing no statistically significant difference (p>0.05). Tirofiban combined with conventional basic treatment can greatly improve neurological deficits and disease outcomes, alleviate platelet adhesion, and reduce platelet activation without increasing the risk of hemorrhage in PIS patients.

Efficacy and Safety of Tirofiban in Clinical Patients With Acute Ischemic Stroke.

BackgroundIntravenous thrombolysis and endovascular thrombectomy have been approved for acute ischemic stroke (AIS). However, only a minority of patients received these treatments in China. We aimed to evaluate the efficacy and safety of tirofiban in patients with AIS who were not undergoing early recanalization treatments.MethodsPatients with mild-to-moderate stroke [National Institutes of Health Stroke Scale (NIHSS) score, 4–15] were enrolled in this study. Patients due to cardiogenic embolism were excluded. Eligible patients within 12 h from symptom onset were randomly assigned (1:1) to receive tirofiban (a loading dose of 0.4 μg/kg/min over 30 min and a maintenance dose of 0.1 μg/kg/min up to 48 h) followed by regular treatment or to receive regular treatment (aspirin at a dose of 100 mg per day for 90 days) (control). The primary outcome was the proportion of favorable functional outcomes at 90 days [defined as the modified Rankin Scale (mRS) score of 0–2]. The secondary outcomes included a shift in the distribution of the mRS scores at 90 days and the NIHSS score at 24 h and 7 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH) within 7 days after tirofiban treatment.ResultsA total of 380 eligible patients were randomly assigned to the tirofiban group (n = 190) or the control group (n = 190). The proportion of favorable functional outcomes was higher in the tirofiban group (79.1%) than that in the control group (67.8%) at 90 days [odds ratio (OR), 1.80; 95% CI, 1.12–2.90; p = 0.0155]. An improvement was also observed in the overall distribution of the 90-day mRS scores (adjusted common OR, 2.31; 95% CI, 1.58–3.39; p < 0.0001). Additionally, the median NIHSS score was lower in the tirofiban group than in the control group at 7 days (3 vs. 5, p < 0.0001). Next, we observed that the occurrence of sICH did not differ between the two groups.ConclusionOur trial supports that tirofiban was safe and effective and might be a remedial treatment for patients with AIS who did not receive recanalization treatments.Clinical Trial Registrationhttp://www.chictr.org.cn/, identifier: ChiCTR2000031297.

Effect of Tirofiban on new cerebral microbleeds after mechanical thrombectomy in patients with acute ischemic stroke.

The aim of this study was to analyze the effect of tirofiban on new cerebral microhemorrhage after mechanical thrombectomy in patients with acute ischemic stroke. In total, 203 patients with acute ischemic stroke treated by mechanical thrombectomy in our department of neurology were enrolled as the research objects. The patients were divided into two groups: the patients who used tirofiban within 24 h after surgery were assigned to the study group (78 subjects), while patients who did not use tirofiban were assigned to the conventional group (125 subjects). Magnetic resonance imaging was used to detect new-onset cerebral microbleeds in patients with stroke after surgery. The National Institute of Health Stroke Scale, modified ranking scale, and activity of daily living scale were used to assess the prognosis of patients, and the general data and the occurrence of adverse effects between two groups were compared to comprehensively evaluate the efficacy and safety of tirofiban. The proportion of atrial fibrillation in the research group was significantly lower than that in the conventional group. The research group had a much lower rate of new-onset cerebral microbleeds than the conventional group (p<0.001). There was no significant difference in the proportion of adverse reactions between the two groups (p>0.05). The application of tirofiban in mechanical thrombectomy of patients with acute ischemic stroke has high safety, effectively reduces the occurrence of new cerebral microhemorrhage, and provides a guarantee for patient safety.

Clinical efficacy and safety of tirofiban combined with conventional dual antiplatelet therapy in ACS patients undergoing PCI

Challenges remain for clinicians over balancing the efficacy of active antithrombotic therapy and simultaneous bleeding reduction in patients. The clinical data of 347 patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) were retrospectively analyzed. On the basis of the given tirofiban, the patients were assigned into three different dose groups: high dose group (group H), medium dose group (group M), and low dose group (group L). The tirofiban efficacy was evaluated in terms of major adverse cardiovascular event (MACE) parameters and lab endpoints, including platelet count and function. The tirofiban safety was assessed by the occurrence of bleeding events. The patients were followed up for 1 month after the PCI. No significant difference in MACE events was evident among these groups (p > 0.05). Groups H and M reported an obvious reduction in platelet count (p < 0.05 for both) and an increased platelet inhibition rate (p < 0.05 for both). Group H showed a higher rate of total bleeding events than the other groups (Group H vs. Group M: 34.4% vs. 16.5%; Group H vs. Group L: 34.4% vs. 10.3%; p < 0.05 for both). A proper administration of a low dose of tirofiban may be a superior alternative in treating ACS patients, which can produce a similar favorable clinical outcome and a decrease in bleeding complication.

Association between tirofiban monotherapy and efficacy and safety in acute ischemic stroke

BackgroundStudies have suggested that glycoprotein IIb/IIIa antagonists such as tirofiban are beneficial for patients with acute coronary syndromes. However, it is still uncertain about the efficacy and safety of tirofiban in patients with acute ischemic stroke (AIS).MethodsIn this prospective non-randomized study, 255 AIS patients were recruited from 4 comprehensive stroke centers in China between January, 2017 and May, 2018. Among them,169 patients were treated with aspirin plus clopidogrel and 86 patients were treated with tirofiban. The primary functional outcome was the distribution of the 90 days’ modified Rankin Scale (mRS). The safety outcomes included the incidence of intracranial hemorrhage (ICH) at discharge and mortality at 3 months.ResultsIn the propensity score matched cohort, tirofiban alone was noninferior to the dual antiplatelet with regard to the primary outcome (adjusted common odds ratio, 0.97; 95% confidence interval, 0.46 to 2.04; P = 0.93). Mortality at 90 days was 10% in the dual antiplatelet group and 8% in the tirofiban group (adjusted odds ratio 0.75; 95% CI 0.08 to 7.40, p = 0.81). There was no difference of the ICH rate between two groups (adjusted odds ratio 0.44; 95% CI 0.13 to 1.48, p = 0.18). In the inverse probability of treatment weighting-propensity score-adjusted cohort, similar differences were found for functional and safety outcomes.ConclusionsOur study suggested that tirofiban use appears to be safe as monotherapy in AIS treatment compared with common dual antiplatelet therapy, however, no improvement in functional outcomes was found.Trial registrationChinese clinical trial registry, ChiCTR2000034443, 05/07/2020. Retrospectively registered.

Assessing the Efficacy and Safety of Tirofiban in Combination With Dual-antiplatelet Therapy in Progressive Ischemic Stroke Patients.

This study assessed the efficacy and safety of tirofiban in combination with dual-antiplatelet therapy (DAPT) in progressive ischemic stroke. One hundred and four patients equally divided into a tirofiban group or DAPT group were enrolled from June 2018 to December 2019. Efficacy outcomes included National Institutes of Health Stroke Scale score for 14 days, and modified Rankin scale (mRs) scores as excellent (mRs 0-1) or favorable (mRs 0-2) measured 90 days after stroke. At 14 days, the tirofiban group had a lower National Institutes of Health Stroke Scale score compared with the DAPT group (F = 14.959, P = 0.000). The mRS scores of the 2 groups at 90 days after treatment were significantly different from those before treatment. At 90 days, excellent favorable functional outcome (mRS ≤ 2) was achieved in 33 of 52 (63.43%) patients in the tirofiban group compared with 25 of 52 (48.08%) patients in the DAPT group. The incidence of bleeding was 5.77% in the tirofiban group, compared with 0% in DAPT group. Intravenous (IV) tirofiban alone or combined with DAPT was shown to be safe and effectively improved clinical outcome in progressive ischemic stroke patients. IV tirofiban was shown to be superior to the DAPT regimen.

Tirofiban combined with heparin’s effect and safety in the treatment of mild to moderate acute ischemic stroke

ABSTRACT Tirofiban can be used to treat patients with acute ischemic stroke (AIS), this study was to evaluate the efficacy and safety of tirofiban combined with heparin in the treatment of mild to moderate AIS. A total of 98 patients with mild to moderate AIS randomly were divided into 2 groups within 48 h: the treatment group treated with tirofiban and, and the control group treated with aspirin + clopidogrel. The treatment group was given the same scheme as the control group after the treatment of tirofiban combined with heparin for 48 h. It was found that, compared with the control group, a significant decreased National Institute of Health stroke scale (NIHSS) was found in 48 h and 14 d, especially to the Barthel index (BI) in the treatment group (P < 0.05). Furthermore, Modified Rankin Scale (MRS, ≤2) in the treatment group was significantly upregulated in 90 d (P < 0.05). However, there were no significant differences in the adverse drug reactions between the two groups. It was indicated that nerve function and long-term prognosis in patients undergoing heparin for mild to moderate AIS were obviously improved than the control group.

Safety and efficacy of tirofiban combined with endovascular treatment in acute ischaemic stroke.

Tirofiban is used off-label in clinical practice for acute ischaemic stroke (AIS). However, it is unknown whether tirofiban increases the bleeding risk or improves the outcome of endovascular treatment (EVT) in AIS. This study evaluated the efficacy and safety of tirofiban in combination with EVT for AIS. Consecutive patients with AIS receiving EVT were included in the prospective stroke registry from 2015 to 2018. The efficacy outcomes were modified Rankin Scale (mRS) score at 3 months and National Institutes of Health Stroke Scale (NIHSS) score at 24 h. The safety outcomes were symptomatic intracerebral hemorrhage (sICH), any in-hospital intracerebral hemorrhage, in-hospital death and 3-month death. Of 211 patients, 82 (38.9%) received tirofiban. A total of 39 (48.1%) with tirofiban and 44 (36.1%) without tirofiban had mRS score 0-2 [adjusted odds ratio (OR), 2.41; 95% confidence interval (CI), 1.11-5.23, P = 0.026]. NIHSS score at 24 h was lower in the tirofiban group (9.5 vs. 12.0, adjusted P = 0.032). Five (6.1%) patients with tirofiban and 16 (12.4%) without tirofiban had sICH (adjusted OR, 0.54; 95% CI, 0.16-1.83, P = 0.32). In-hospital intracerebral hemorrhage occurred in 10 (12.2%) patients with tirofiban and 41 (31.8%) without tirofiban (adjusted OR, 0.32; 95% CI, 0.13-0.76, P = 0.01). In-hospital death occurred in 7 (8.5%) patients with tirofiban and 16 (12.4%) without tirofiban (adjusted OR, 0.69; 95% CI, 0.22-2.13, P = 0.52). A total of 13 (15.9%) patients with tirofiban and 22 (17.1%) without tirofiban were dead at 3 months (adjusted OR, 0.98; 95% CI, 0.40-2.40, P = 0.96). Tirofiban in combination with EVT was associated with a lower mRS score at 3 months and NIHSS score at 24 h. It was not associated with a higher rate of sICH, in-hospital death and death at 3 months.

Safety and efficacy of Tirofiban in STEMI-patients

BackgroundTirofiban is recommended as bail out therapy in patients with ST-elevation myocardial infarction (STEMI). However, evidence regarding safety and efficacy of tirofiban is unclear. Tirofiban has been shown to improve ST-resolution, to decrease infarct size (IS) and to reduce incidence of major adverse cardiac and cerebrovascular events (MACCE). However, bleeding is enhanced in tirofiban treated patients. In this study, we aim to investigate efficacy and safety of Tirofiban in STEMI-patients. Methods610 STEMI patients were analyzed. MACCE (death, myocardial infarction [MI], stroke) and TIMI bleeding events were registered during hospital course and 12 month follow-up. ResultsTirofiban patients were slightly younger (tirofiban 63 ± 13 years vs. control 65 ± 14 years; p = 0.04). They had higher peak-high-sensitive troponin T [Hs-TnT] (tirofiban 6561 ± 11,065 vs. control 4594 ± 11,200, p-value = 0.047) and peak-creatine kinase [CK] (tirofiban 2742 ± 5097 vs. control 1416 ± 2160, p-value < 0.0001). Percutaneous coronary intervention (PCI) was more complex in tirofiban treated patients as radiation time (tirofiban 18 ± 15 vs. control 14 ± 13; p-value = 0.02) and use of contrast agent (tirofiban 240 ± 106 vs. control 209 ± 99; p-value = 0.01) was higher in tirofiban patients. However, there were no differences in MACCE (HR 0.877, 95% CI 0.62–1.25, p = 0.47) and bleeding (major: HR 1.494, 95% CI 0.65–3.44, p = 0.34; minor: HR 1.294, 95% CI 0.67–2.52, p = 0.45). ConclusionMACCE and bleeding events were similar. However, PCI was more complex and infarcts larger in tirofiban treated patients.

Comprehensive analysis clinical effectiveness of Tirofiban for patients with non-ST-elevation acute coronary syndrome

Background: To systematically assess the effectiveness and safety of tirofiban in patients with non-STelevation acute coronary syndromes (NSTE-ACS). Methods: We search the online databases in both English and Chinese from inception to 2017 to collect randomized controlled trials about tirofiban for NSTE-ACS patients in early medicine conservative treatment. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Results: A total of 10 randomized controlled trials were enrolled involving 6405 patients. The results of meta-analysis showed that: (1) The incidences of cardiovascular events of composite endpoints in the trial group were lower than that in the control group (during One week: relative risk (RR)=0.55, 95% confidence interval (95%CI: 0.40, 0.74, P<0.001) and the incidences of cardiovascular events of composite endpoints in the trial group were lower than that in the control group (during 30 days: RR=0.45, 95%CI0.40, 0.75, P<0.001). (2) The incidence of bleeding in the trial group was higher than that in the control group (RR=1.31, 95%CI: 1.00-1.72). Conclusions: Compared with routine treatment alone, tirofiban has better therapeutic effects in early conservative treatment for patients with non-ST-elevation acute coronary syndromes, but the incidence of bleeding is relatively high.

Safety of tirofiban in patients with acute cerebral infarct receiving endovascular therapy

To investigate the effect of tirofiban on hemorrhagic transformation and neurological outcome in patients with acute cerebral infarct treated with endovascular therapy. One hundred and fifteen patients with acute cerebral infarct who received endovascular stent mechanical thrombectomy in the Second Affiliated Hospital, Zhejiang University School of Medicine during October 2013 and April 2017 were included in the study. Among 115 patients, 30 received tirofiban treatment. Hemorrhagic transformation and neurological outcomes were assessed using the ECASS Ⅱ criteria and modified Rankin scale (mRS), respectively. Unfavorable outcome was defined as mRS>2. Binary logistic regression model was used to analyze the independent predictors of hemorrhagic transformation and neurological outcome. Binary logistic regression analysis showed that tirofiban treatment did not increase the risk of hemorrhagic transformation (OR=0.437, 95% CI:0.168-1.132, P>0.05); baseline NIHSS (OR=1.136, 95% CI:1.014-1.273, P<0.05), recanalization (OR=0.060, 95% CI:0.010-0.365, P<0.01), hypertension (OR=4.233, 95% CI:1.320-13.570, P<0.05) and onset to treatment time(OR=1.006, 95% CI:1.001-1.011, P<0.05) were independently associated with unfavorable outcome, while such association was not observed in tirofiban treatment (OR=1.923, 95% CI:0.536-6.568, P>0.05). Tirofiban appears to be safe for patients with acute cerebral infarct receiving endovascular therapy.

Effect and safety of tirofiban in PCI patients with non-ST elevation acute coronary syndrome

Objective To investigate the effect and safety of tirofiban in PCI patients with non-ST elevation acute coronary syndrome(NSTE-ACS). Methods 80 high-risk patients were randomly divided into treatment group(tirofiban+ PCI) and control group(PCI). Collected all the clinical and coronary angiography.The coronary reperfusion flow(TIMI grade) of the culprit vessel after PCI, ultrasound cardiogram 1 week after PCI, bleed events, major adverse cardiac events with 30 days and one year, and heart function status were compared between the two groups. Results TIMI after PCI, major adverse cardiac events within 30 days, heart function status after one year, revascularization within 1 year in the treatment group were superior to the control group(χ2=42, 3, 2, 28, all P<0.05). Conclusion Tirofiban is safe and effective for elderly patients with NSTE-ACS received PCI. Key words: Myocardial infarction; Tirofiban; Interventional therapy

The effect and safety of tirofiban on acute ST segment elevation myocardial infarction patients receiving no early reperfusion therapy

To study the efficacy and safety of tirofiban on acute ST segment elevation myocardial infarction (STEMI) in patients who do not receive early reperfusion therapy. A total of 153 STEMI patients without early reperfusion therapy were randomly distributed into tirofiban group (therapeutic group, n=78) and non-tirofiban group (control group, n=75). Coronary angiography was performed on the 5(th) and 10(th) day after treatment, and percutaneous coronary intervention (PCI) was conducted when necessary. The differences of initial patency of the infarct related artery (IRA), bleeding complication and clinic events within 30 days between these two groups were compared. Tirofiban did not increase the percentage of patients with initial patency of IRA (60.3% vs 64.0%, P=0.63). The percentage of patients with thrombolysis in myocardial infarction (TIMI) 3 after PCI was 100.0% in tirofiban group and 97.1% in the control group (P=0.09). However, application of tirofiban significantly decreased poor myocardial perfusion rate after PCI (1.4% vs 8.8%, P=0.04). No significant differences were observed in major adverse cardiovascular events (MACE) (3.8% vs 2.7%, P=0.68) between therapeutic and control group. The same is true for mild (5/78 vs 4/75 cases, P=0.78) and severe hemorrhage (2/78 vs 1/75 cases, P=0.58), and severe thrombocytopenia (2/78 vs 0/75 cases, P=0.10) between these two groups within 30 days. Tirofiban did not increase initial patency in STEMI patients without early reperfusion therapy. However, it can improve myocardial perfusion after PCI.