Tirofiban Therapy Research Articles

Abstract 13: Intravenous Tirofiban as An Adjunct to Endovascular Therapy for Posterior Circulation Strokes with Tandem Lesions: One-Year Outcomes

Background: The effectiveness and safety of intravenous Tirofiban as an adjunct to endovascular therapy (EVT) in posterior circulation patients with tandem lesions (PCTL) remain uncertain. Methods: This study utilized individual patient data pooled from two multicenter observational studies: the BASILAR and the PERSIST registries. We included patients with acute ischemic stroke due to PCTLs who were treated with EVT. The patients were divided into two groups based on whether they received adjunctive intravenous Tirofiban therapy or not. The primary efficacy outcome was favorable functional outcome, defined as modified Rankin Scale (mRS) scores of 0-3 at one year. Secondary outcomes included safety assessments, such as rates of symptomatic intracerebral hemorrhage (sICH), early neurological deterioration (defined as a decline in National Institutes of Health Stroke Scale [NIHSS] score by ≥4 points within 72h), and all-cause mortality at one year. We also evaluated procedural outcomes, including successful reperfusion, defined as modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b-3, and complete reperfusion, defined as mTICI 3. Results: Among 210 patients treated with EVT (126 Tirofiban, 84 Non-Tirofiban), successful reperfusion (mTICI 2b-3) was achieved in 109 (86.5%) Tirofiban patients versus 64 (76.2%) non-Tirofiban patients (Adjusted OR 1.75, 95%CI [0.76-4.03], P=0.19). Complete reperfusion (mTICI 3) was achieved in 74 (58.7%) Tirofiban patients versus 36 (42.9%) non-Tirofiban patients (Adjusted OR 2.08, 95%CI [1.04-4.14], P=0.04). Rates of sICH were 6 (4.8%) in the Tirofiban group versus 9 (10.7%) in the non-Tirofiban group (Adjusted OR 0.24, 95%CI [0.04-1.36], P=0.11). Early neurological deterioration occurred in 18 (14.3%) Tirofiban patients versus 32 (38.1%) non-Tirofiban patients (Adjusted OR 0.20, 95%CI [0.09-0.46], P<0.001). One-year mRS 0-3 was achieved in 48/119 (40.3%) Tirofiban patients versus 24/82 (29.3%) non-Tirofiban patients (Adjusted OR 5.38, 95%CI [2.21-13.06], P<0.001). One-year mortality was 45/119 (37.8%) in the Tirofiban group versus 43/82 (52.4%) in the non-Tirofiban group (Adjusted OR 0.26, 95%CI [0.12-0.59], P=0.001). Conclusion: Intravenous Tirofiban as an adjunct to EVT may improve long-term functional outcomes in acute ischemic stroke patients due to PCTLs without significantly increasing the risk of hemorrhagic complications. Further prospective studies are warranted to validate these findings.

EFFICACY OF INTRAVENOUS TIROFIBAN THERAPY IN LACUNAR STROKE PATIENTS

Background: Lacunar ischemic infarcts are small-sized infarcts that develop as a result of occlusion of perforating arteries. Although its pathophysiology differs from other stroke types, there is no separate treatment option from non-cardioembolic strokes. Early neurological worsening in lacunar strokes is a common condition reported up to 41%. There is no effective treatment method to prevent or correct progression. Tirofiban is a reversible receptor antagonist of glycoprotein IIb/IIIa. There are cohort studies with small number of cases related to its use in ischemic stroke. We wanted to evaluate its effectiveness on the progression of lacunar stroke because it is a powerful antiplatelet agent. Objective: Tirofiban is a reversible receptor antagonist of glycoprotein IIb/IIIa. There are cohort studies with small number of cases related to its use in ischemic stroke. We wanted to evaluate its effectiveness on the progression of lacunar stroke because it is a powerful antiplatelet agent. Methods: The data of patients who were followed up in our clinic with the diagnosis of lacunar stroke between August 2020 and May 2022 and who received tirofiban treatment were evaluated retrospectively. Patients' ages, infarct localizations, NIHSS scores at admission, at the beginning and end of tirofiban treatment, and 3rd month mRS scores were recorded. Results: Fifteen patients, 11 male and 4 female, were included in the study. The mean age of the patients was 68.73±9.58 (range, 51-85). Tirofiban was started proactively in 2 patients, after progression in 13 patients. The NIHSS scores were 7.20±2.65 at the start of the infusion, and 4.80±3.93 after the infusion, and the decrease was statistically significant (P=0.010). Conclusion: These findings suggest that intravenous tirofiban therapy is a safe and effective treatment option to stop symptomatic fluctuations and shorten the duration of deficit in patients with progressive lacunar stroke.

Glycoprotein IIb/IIIa inhibitors in the treatment of thromboembolic events related to endovascular treatment of cerebral aneurysms-systematic review and meta-analysis.

Thromboembolism complication is considered the most common complication associated with the treatment of endovascular. This systematic review and meta-analysis aimed to assess the studies investigating the effect of glycoprotein IIb/IIIa inhibitor agents on thromboembolic complications during endovascular aneurysm coiling. This systematic review investigated the outcome of the use of three glycoprotein IIb/IIIa inhibitor agents (ie abciximab, tirofiban, and eptifibatide) on the thromboembolic complications during endovascular aneurysm coiling. The electronic databases of PubMed, Web of Science, Scopus, and Medline were searched up to 25 June 2021, using the keywords "Abciximab," "Tirofiban," and "Eptifibatide" incombination with "Thromboembolism Complication," "Aneurysms," and "Endovascular Aneurysm Coiling." A total of 21 articles were found to be eligible and included in this review. The rates of complete and partial recanalization were estimated to be 56% and 92% in patients who underwent abciximab and tirofiban therapy, respectively. Rupture aneurysms were found in the majority of patients. In general, the mortality rate of the patients treated for thromboembolic complications during endovascular treatment of cerebral aneurysms with glycoprotein IIb/IIIa inhibitors was found to be 4.8% (CI 95%:0.027-0.067; p < .005). The average remission rate in studies investigating thromboembolism was 91% (CI 95%:0.88-0.95, I2 : 65.65/p < .001). Based on the obtained results, a higher mean rate of complete recanalization by eptifibatide was found in studies in which abciximab or tirofiban were used, compared to other mentioned agents. Moreover, the amount of hemorrhage was reported to be less after using tirofiban rather than abciximab.

Abstract TP143: Endovascular Treatment With Versus Without Tirofiban For Stroke Patients With Large Vessel Occlusion: The Multicenter, Randomized, Placebo-controlled, Double-blind RESCUE BT Clinical Trial

Background: As a glycoprotein IIb/IIIa receptor inhibitor, tirofiban may help reduce the risk of vascular complications during percutaneous transluminal coronary intervention. However, evidence on whether tirofiban improve the outcomes of stroke patients with large vessel occlusion who are receiving endovascular treatment is limited. Objective: This trial aims to assess whether additional intravenous tirofiban therapy can improve the clinical outcomes of stroke patients with large vessel occlusion who undergo endovascular treatment within 24 hours of symptom onset. Methods and Design: The Endovascular Treatment With versus Without Tirofiban for Stroke Patients With Large Vessel Occlusion (RESCUE BT) Trial is an investigator-initiated, randomized, placebo-controlled, double-blind, multicenter trial. Up to 930 eligible patients will be consecutively randomized to tirofiban or control group in 1:1 ratio over three years from approximate 50 endovascular-capable stroke centers in China. Outcomes: The primary end-point is the disability level measured by overall distribution of the 90-day modified Rankin Scale score. The primary safety end-points are symptomatic intracerebral hemorrhage at 48 hours and mortality at 90 days. Trial status: The trial screening and enrollment began on 10 October, 2018, and now the randomization is still ongoing. We expect that the enrollment will be end in October 2021, and the trial results will be revealed in February 2022. Trial registry number: ChiCTR-INR-17014167 ( www.chictr.org.cn ).

Endovascular treatment with versus without tirofiban for stroke patients with large vessel occlusion: The multicenter, randomized, placebo-controlled, double-blind RESCUE BT study protocol

Tirofiban, a glycoprotein IIb/IIIa receptor inhibitor, has been shown to reduce the risk of thrombotic complications during percutaneous coronary intervention. However, it remains unknown whether tirofiban improves outcomes in large vessel occlusion stroke patients undergoing endovascular treatment. This trial aims to assess whether additional intravenous tirofiban therapy can improve the clinical outcomes in large vessel occlusion stroke patients who undergo endovascular treatment within 24 h of symptom onset. The Endovascular Treatment With versus Without Tirofiban for Stroke Patients With Large Vessel Occlusion (RESCUE BT) Trial is an investigator-initiated, randomized, placebo-controlled, double-blind, multicenter trial. Up to 930 eligible patients will be consecutively randomized to intravenous tirofiban or placebo in 1:1 ratio over 3 years across 50 endovascular-capable stroke centers in China. The primary end point is the disability level as measured by overall distribution of the 90-day modified Rankin Scale scores. Primary safety end points include symptomatic intracerebral hemorrhage at 48 h and mortality at 90 days. ChiCTR-INR-17014167 (www.chictr.org.cn).

Modulators of Mortality Benefit From Peri-Angioplasty Adjunctive Tirofiban in Patients With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

Studies investigating the modulators of mortality benefit conferred by peri-angioplasty glycoprotein IIb/IIIa inhibitors in ST-elevation myocardial infarction (STEMI) are still lacking.Methods and Results:A prospective database (n=1,025) of consecutive cases undergoing primary percutaneous coronary intervention for STEMI was retrospectively analyzed. For patients in Killip class I, II or III, IV, the multivariate-adjusted hazard ratios of 30-day all-cause mortality associated with adjunctive tirofiban were 3.873 (95% CI 0.504-29.745; P=0.193), 0.550 (95% CI 0.188-1.609; P=0.275), and 0.264 (95% CI 0.099-0.704; P=0.008), respectively. The P value for a linear trend was 0.032. Patients who had a body mass index (BMI) within 22.9-25.0 kg/m2had a significant benefit from tirofiban (adjusted HR 0.344; 95% CI 0.145-0.814; P=0.015) compared to other BMI groups. The P value for a quadratic trend was 0.012. A novel Killip-BMI score (KBS = 2.5 × Killip category - | BMI - 24 |) was calculated to select the beneficial population. A KBS ≥2 was associated with significant mortality benefit, whereas a KBS <0 predicted increased 30-day mortality with tirofiban use. Survival benefit from peri-angioplasty tirofiban therapy for STEMI was positively correlated with the Killip class. Tirofiban should be used cautiously in either underweight or overweight patients. The novel KBS used in this study can guide peri-angioplasty use of adjunctive tirofiban in patients with STEMI undergoing primary angioplasty.

Predictive value of the age, creatinine and ejection fraction score in patients undergoing primary percutaneous coronary intervention with bail-out tirofiban therapy.

IntroductionIn patients who have undergone interventional cardiac procedures, the risk of bleeding is higher than in patients who received conservative treatment due to multiple medications and comorbidities.AimThis study aimed to evaluate the usefulness of the age, creatinine and ejection fraction (ACEF) score for predicting bleeding events and to compare short- and long-term clinical outcomes according to the ACEF score in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) with bail-out tirofiban therapy (BOTT).Material and methodsA total of 2,543 patients were included and divided into three groups according to the following ACEF score tertiles: T1 (ACEFlow ≤ 1.033), T2 (1.033 < ACEFmid ≤ 1.371), and T3 (ACEFhigh > 1.371). The main outcomes measured were the incidence rates of relevant bleeding events and mortality within 30 days and 3 years after the procedure.ResultsA total of 73 (2.9%) patients had Bleeding Academic Research Consortium bleeding events of grades 3, 4 or 5 and 104 (4%) patients died in a 30-day period. The ACEF score was effective at predicting 30-day bleeding (area under the receiver operating characteristic curve (AUC): 0.658, 95% confidence interval (CI): 0.579–0.737; p < 0.001), 30-day mortality (AUC = 0.701, 95% CI: 0.649–0.753; p < 0.001) and 3-year mortality (AUC = 0.778, 95% CI: 0.748–0.807; p < 0.001) events. Considering the ACEF score tertiles, T3 patients presented greater 30-day bleeding (1.6%, 2.8% and 4.1%; odds ratio (OR) = 2.56, 95% CI: 1.37–4.80), 30-day mortality (1.7%, 3.5% and 7.1%; OR = 4.53, 95% CI: 2.51–8.18) and 3-year mortality (6.4%, 11% and 19.8%; hazard ratio = 3.56, 95% CI: 2.58–4.91) risks.ConclusionsThe ACEF score is a user-friendly tool with excellent predictive value for bleeding events and mortality in patients undergoing pPCI with BOTT.

Increased risk of Ventriculostomy-Associated hemorrhage in patients treated with antiplatelet agents for stent-assisted coiling of ruptured intracranial aneurysms

Purpose The aim of this study is to evaluate the impact of antiplatelet agents for stent-assisted coiling, including intravenous (IV) tirofiban as an antiplatelet premedication, on rates of external ventricular drain (EVD)-related hemorrhage in acutely ruptured intracranial aneurysms. The impact of IV tirofiban in particular was also evaluated. Methods Rates of radiographically identified hemorrhage associated with EVD placement were compared between patients who received an antiplatelet agent for stent-assisted coil embolization (SACE), and patients who did not receive an antiplatelet agent between June 2013 and June 2019. Results 78 patients treated for a ruptured aneurysm which required an EVD were included. A total of 46 patients who underwent stent-assisted coiling and received IV tirofiban and oral asipirin and clopidogrel (DAPT) were included in the antiplatelet group, while 32 who underwent single coiling and received no antiplatelet therapy were included in the control group. Overall, EVD-related hemorrhage occurred in 13 patients (16.67%): 11 (23.91%) in the antiplatelet group and 2 (6.25%) in the control group (p = 0.040). Of 37 patients who underwent computed tomography after SACE, but before the use of DAPT, 8 (21.62%) exhibited EVD-related hemorrhage after IV tirofiban therapy (p = 0.070 vs. control group). EVD-related hemorrhage was not significantly different between patients with EVD placement after coil embolization versus before coil embolization (p = 0.124). In the subgroup analysis for the antiplatelet group, we did not observed increased EVD-related hemorrhage in patients receiving EVD placement after administration of antiplatelet agents (8/27 [29.63%]) versus before administration of antiplatelet agents (3/19 [15.79%]). Conclusion Patients with ruptured aneurysm who receive an antiplatelet agent for stent-assisted coiling are at a higher risk for EVD-related hemorrhage. The order of EVD placement and EVT, as well as the order of EVD placement and antiplatelet initiation do not appear to be significantly different regarding the outcome of EVD-related hemorrhage. Highlights Patients with ruptured aneurysm who receive an antiplatelet agent for stent-assisted coiling are at a higher risk for EVD-related hemorrhage. There was a trend towards higher EVD related haemorrhage when tirofiban was used but it did not reach statisitical significance. The order of EVD—whether before vs after endovascular treatment, or before vs after antiplatelet therapy did not influence the EVD-related hemorrhage rates.

Safety and efficacy of tirofiban in acute ischemic stroke patients not receiving endovascular treatment: a systematic review and meta-analysis.

The purpose of this systematic review and meta-analysis was to analyze the safety and efficacy of tirofiban when used for acute ischemic stroke (AIS) patients not undergoing endovascular treatment. An electronic search was performed for English-language studies on PubMed, Scopus, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases up to 31st July 2019. All types of studies comparing tirofiban monotherapy or combined intravenous (IV) thrombolysis and tirofiban therapy with controls for AIS patients were included. Six studies were included in the review. Three evaluated tirofiban monotherapy while three compared IV thrombolysis and tirofiban therapy with controls. Meta-analysis indicates that tirofiban monotherapy does not significantly increase the incidence of intracerebral hemorrhage (ICH) (Odds Ration [OR] 1.14, 95% CI 0.72-1.82, p = 0.57; I2 = 0%), symptomatic intracerebral hemorrhage (sICH) (OR 0.52, 95% CI 0.09-3.03, p = 0.46; I2 = 0%) and mortality (OR 0.53, 95% CI 0.13-2.07, p = 0.36; I2 = 63%) in AIS patients. Similarly, our analysis indicates no significant increase in the rates of ICH (OR 0.82, 95% CI 0.33-2.07, p = 0.68; I2 = 0%), sICH (OR 0.91, 95% CI 0.16-5.16, p = 0.91; I2 = 0%) and mortality (OR 1.50, 95% CI 0.42-5.38, p= 0.54; I2 = 0%) in AIS patients treated with combined IV thrombolysis and tirofiban therapy. Meta-analysis for functional outcome was not possible. To conclude, tirofiban appears to be safe when used following IV thrombolysis or as monotherapy in AIS patients. Conclusions regarding improvement in functional improvement cannot be drawn. Further trials are needed to strengthen the evidence on this topic.

Effect of Up-Stream Tirofiban Therapy in STEMI Patients, Who Are Not Candidates for Primary Reperfusion Strategy with Thrombolysis and Undergoing Delayed PCI: A Single Tertiary Care Centre Observational Study

Effect of Up-Stream Tirofiban Therapy in STEMI Patients, Who Are Not Candidates for Primary Reperfusion Strategy with Thrombolysis and Undergoing Delayed PCI: A Single Tertiary Care Centre Observational Study

Shock Index on Admission Is Associated with Coronary Slow/No Reflow in Patients with Acute Myocardial Infarction Undergoing Emergent Percutaneous Coronary Intervention.

Objective Coronary slow/no reflow is not rare after successfully undergoing primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI), and shock index (SI) is an important factor for adverse cardiovascular prognosis. In this study, we are to explore whether SI is associated with coronary slow/no reflow in patients with AMI following primary PCI. Methods A total of 153 consecutive AMI patients undergoing primary PCI within 24 hours of symptom onset were included in this study. The participants were divided into normal flow group (n=124) and slow/no reflow group (n=29) according to cineangiograms recorded during the period of PCI. Cardiovascular risk factors, hematologic parameters, preoperative management of antithrombotic therapy, and baseline angiography were collected. Results SI, plasma glucose, white blood cells (WBC) and neutrophil count, neutrophil to lymphocyte ratio (PLR), high sensitivity C-reactive protein (hs-CRP), probrain natriuretic peptide (pro-BNP), and Killip classification on admission and thrombus burden on initial angiography were significantly different between patients with and without slow/no reflow. Multivariate analysis revealed that SI≥0.66, thrombus burden, and plasma glucose on admission were independent predictors for coronary slow/no reflow. Preoperative management of tirofiban therapy improves initial thrombolysis in myocardial infarction (TIMI). However, it has no effect on prognosis of slow/no reflow. Conclusion Our findings demonstrated that slow/no reflow in patients with AMI following primary PCI was more likely associated with SI≥0.66, thrombus burden, and plasma glucose on admission. SI as a predictor for coronary slow/no reflow should be further confirmed in the following more large-scale and prospective studies. The clinical registration number is ChiCTR1900024447.

Rescue Stenting Using Neuroform Atlas Stent During Coiling Protrusion for Ruptured Intracranial Aneurysms

Endovascular coiling is generally considered as an effective treatment option for ruptured intracranial aneurysms. Increasing operator experience and quality of tools determined an improvement of endovascular cerebral aneurysms' treatment. However, procedure-related complications still occur. The purpose of this study is to report a series of rescue stenting procedures with the Neuroform Atlas (NA) open-cell stent, for intraprocedural complications during coil embolization in patients with ruptured intracranial aneurysms. Between April 2016 and January 2018, 12 consecutive coil protrusions that occurred during ruptured aneurysms' embolizations were rescued using NA stenting together with tirofiban therapy. Follow-up was performed with initial magnetic resonance angiography (MRA) at 1 month and then MRA plus standard digital subtraction angiography at 11-13 months after the procedure. Technical success was achieved in 100% of patients. No NA stent delivery/deployment complication occurred. Initial MRA showed complete occlusion of the aneurysm, with evidence of blood flow into parent vessels in 12 out of 12 cases. At 11-13 months, MRA and digital subtraction angiography showed 10 complete occlusion cases and 1 partial occlusion case. At 2 months, 1 death occurred due to subarachnoid hemorrhage. The open-cell NA stent represents a rescue option for coil protrusion during endovascular treatment of ruptured intracranial aneurysms allowing regular restoration of blood flow and minimizing thromboembolic events.

Intravenous tirofiban therapy for patients with capsular warning syndrome

BackgroundCapsular warning syndrome (CWS) is defined as recurrent episodes of transient ischaemic attacks ≥3 times during a short time frame. There is no effective therapy to stop these attacks. We,...

Severe Thrombocytopenia Due to Intravenous Tirofiban Therapy

Patti, Ravikaran MBBS1; Sinha, Ankur MBBS1; Rodriguez, Daniel MD2; Khanijao, Suchit MD1; Topi, Bernard MD2; Somal, Navjot MD1 Author Information

Thrombectomy with Solitaire stent for treating acute middle cerebral artery occlusion

Objective To assess the efficacy and safety of thrombectomy with Solitaire stent for treatment of acute middle cerebral artery occlusion (MCAO), and to identify the predictive factors for clinical outcome. Methods A total of 25 patients with acute middle cerebral artery (MCA)-M1 segment occlusion were treated by thrombectomy with Solitaire stent. Time from onset to femoral artery puncture, time from femoral artery puncture to recanalization, times of thrombectomy, thrombolytic therapy or not, balloon dilatation and/or stent implantation, intraarterial thrombolysis or not, tirofiban treatment after therapy or not were recorded. Vascular recanalization immediately after procedure was evaluated by Thrombolysis in Cerebral Infarction (TICI). National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological function of patients 24 h after operation, and the clinical outcomes were assessed by modified Rankin Scale (mRS) at 90 d after treatment. The occurrence rate of symptomatic intracranial hemorrhage within 24 h after operation and mortality within 90 d after treatment were recorded. Results Median time from onset to femoral artery puncture was 5.00 (4.00, 6.30) h; median time from femoral artery puncture to recanalization was 2.00 (2.00, 2.50) h; times of thrombectomy was 2 (2, 2); 7 patients (28%) received intravenous thrombolysis before thrombectomy; 6 patients (24%) underwent balloon dilatation only; 3 patients (12%) underwent stent implantation only; 4 patients (16%) underwent balloon dilatation and stent implantation; 4 patients (16%) received intraarterial thrombolysis after thrombectomy; 11 (44%) received tirofiban therapy after operation. There were 20 patients (80% ) of recanalization with TICI 2b-3 grade. The NIHSS score at 24 h after operation was significantly decreased than before procedure [8 (4, 12) score vs. 14 (11, 17) score; Z = -3.532, P = 0.000]. Symptomatic intracranial hemorrhage occurred in 3 patients (12%). At 90 d after treatment, 15 patients (60%) had favorable prognosis (mRS ≤ 2 score). Two patients (8%) died. Univariate and multivariate forward Logistic regression analysis showed the TICI 2b-3 grade was independent factor for favorable prognosis ( OR = 0.316, 95% CI: 0.102-0.982; P = 0.046). Conclusions Thrombectomy with Solitaire stent is safe and effective for treating acute MCAO. With the increase of TICI grade, the prognosis is better. DOI: 10.3969/j.issn.1672-6731.2017.11.004

Safety and preliminary efficacy of intravenous tirofiban in acute ischemic stroke patient without arterial occlusion on neurovascular imaging studies

BackgroundThere has been no effective treatment for acute ischemic stroke (AIS) patients who presented to the Emergency Department >4.5h without a visible arterial occlusion on the neurovascular imaging studies. In this study, we aimed to investigate whether intravenous antiplatelet agent tirofiban was safe and potentially effective in AIS patients who had no visible arterial occlusion and was outside of treatment window for Alteplase. The goal of this study was to collect preliminary data to plan a future phase II study. MethodTwenty-five patients received intravenous tirofiban therapy. The safety outcomes were assessed by the incidence of symptomatic intracerebral hemorrhage (sICH), systematic bleeding and mortality. Efficacy outcomes were evaluated with National Institutes of Health Stroke Scale (NIHSS) score at day 7 (or discharge) and modified Rankin Scale (mRS) at 90days. Outcomes for these patients were compared with a historical age-gender-admission-NIHSS matched cohort treated with aspirin and/or clopidogrel. ResultsThe rate of intracerebral hemorrhage, systematic bleedings, and death were not found in both groups. At day 7 or discharge, the neurological function improved significantly in both treatment groups. However, the NIHSS score was lower in tirofiban group compared with the control group (2 vs.3, p=0.045). At 3months, more patients in tirofiban group had favorable outcomes (mRS 0–1) compared with control group (84% vs. 52%; adjusted odds ratio: 10.57; 95% CI: 1.54–72.33; p=0.016). ConclusionsIntravenous tirofiban appears to be safe and potentially effective for the ischemic stroke patients with no artery occlusion on neurovascular imaging studies and being out of the window for thrombolytic therapy. A next logic step is to plan for a phase II study.

Bridging with Tirofiban during Oral Antiplatelet Interruption: A Single-Center Case Series Analysis Including Patients on Hemodialysis.

Patients requiring an interruption in dual-antiplatelet therapy (DAPT) within 6 months of cardiac stenting are at risk for thrombotic events. Bridging with short-acting intravenous antiplatelet agents has been proposed to minimize the risk of thrombotic and hemorrhagic complications. This retrospective analysis of a tirofiban bridging strategy did not use an initial bolus loading dose. Tirofiban infusions were initiated 24-48 hours after the last oral antiplatelet dose at a rate of 0.1 μg/kg/min (or 0.05 μg/kg/min if renal dysfunction) and continued until 4-8 hours before surgery or until DAPT could be resumed. Coprimary end points were occurrence of major adverse cardiac events (MACE) and bleeding. Twenty patients requiring DAPT interruption within 6 months of cardiac stenting for either a surgical procedure or who were unable to take any medications by mouth were included. The median time from stent implantation to DAPT interruption was 33 days (range 3-146 days). Two patients experienced a MACE during their hospital stay. No major bleeding events occurred; minor bleeding occurred in four patients during tirofiban therapy. Five patients in this analysis had end-stage renal disease requiring hemodialysis. Of these patients, no MACE or major bleeding events occurred. This analysis observed that a tirofiban bridging strategy without an initial bolus loading dose has comparable efficacy and safety as previously published reports. A tirofiban infusion without bolus dosing may be a safe option for antiplatelet bridging in patients with a recent cardiac stent implant to prevent stent thrombosis.

Effects of intracoronary arterial injection of tirofiban on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention

Objective: To compare the effect of intracoronary arterial injection of tirofiban and sodium nitroprusside (SNP) on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI). Methods: A total of 68 patients with acute STEMI who had no-reflow phenomenon during PCI were chosen and randomly divided into SNP group (n = 34) and tirofiban group (n = 34). Aiming at no-reflow phenomenon during PCI, with the use of microcatheters, intracoronary arterial injection of tirofiban was given in tirofiban group, while intracoronary bolus of SNP was given in SNP group. Coronary angiography was conducted to record TIMI flow grade of the infarct-related artery after 10 minutes. Plasma brain natriuretic peptide (BNP) was monitored before and after PCI (in 24 hours). With the help of ultrasound cardiogram, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular endsystolic dimension (LVESD) were recorded and compared in 30 days after PCI. Results: The ratio of TIMI grade 3 blood flow in tirofiban group was significantly higher than that in SNP group [76.5% (26/34) vs. 52.9% (18/34), p = .03]. BNP levels in two groups had no statistical significance before PCI ( p = .16), but in 24 h after PCI, BNP levels in tirofiban group were significantly lower than those in SNP group [(439.00 ± 4.90) μmol/L vs. (632.00 ± 3.63) μmol/L, p = .02]. In 30 days after PCI, LVEF, LVEDD and LVESD in tirofiban group were all superior to those in SNP group (all p < .05). Conclusions: Intracoronary arterial injection of tirofiban was superior to SNP in improving no-reflow phenomenon in STEMI patients after PCI in the emergency treatment. Tirofiban therapy can increase coronary blood flow and myocardial perfusion after the occurrence of no-reflow phenomenon during PCI in STEMI patients, and improve long-term prognosis.

High-dose bolus tirofiban versus low-dose bolus in patients with acute coronary syndrome undergoing percutaneous coronary intervention.

Aim of the present study was to determine effects of high-dose versus low-dose intravenous (IV) bolus tirofiban on angiographic measures, ST resolution, enzymatic infarct size, and clinical outcomes in patients with acute coronary syndrome (ACS) who were undergoing percutaneous coronary intervention (PCI) and received current pharmacoinvasive therapy. Acute coronary syndrome patients (n=271, 85.6% male; mean age: 57.9±12.6 years) from between 2009 and 2015 who received IV tirofiban therapy following PCI were retrospectively analyzed. All patients had received maintenance tirofiban infusion (0.15 µg/kg/min) after bolus dose and 600 mg clopidogrel. Percentage of patients undergoing drug eluting stent implantation procedure was 33.5%. Tirofiban was administered to all patients in bailout situation or for thrombotic complication after PCI. High-dose IV bolus group (25 µg/kg; n=140) was associated with greater ST segment resolution (66% vs. 50%, p=0.013) and reduced peak troponin release [12.4 ng/dL (range: 6.5-21.5 ng/dL) vs. 16.4 ng/dL (range: 10.1-27.4 ng/dL), p=0.001] compared with low-dose bolus group (10 µg/kg, n=131). Cardiovascular event rates were similar between groups at in-hospital, 1-month, and 6-month follow-up (p=1.000, 1.000, and 0.287, respectively). Percentage of patients with post-procedural Thrombolysis in Myocardial Infarction (TIMI) grade III flow, major, and minor bleeding were similar (p=0.085, 1.000, and 0.965, respectively). Use of high-dose IV bolus tirofiban in addition to aspirin and high-dose clopidogrel improves ST segment resolution, reduces infarct size, and does not increase bleeding events in patients with ACS undergoing PCI compared with low-dose bolus. Angiographic measures and clinical endpoints were similar between groups.

The association of the coronary thrombus burden with all-cause mortality and major cardiac events in ST-segment elevation myocardial infarction patients treated with tirofiban.

The aim of this study was to investigate the association of the coronary thrombus burden with all-cause mortality and major adverse cardiac events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients treated with 'in-cath lab' (downstream) high-dose bolus tirofiban. This study included 2452 patients with STEMI treated with a primary percutaneous coronary intervention. All glycoprotein IIb/IIIa receptor inhibitor (GPI) (tirofiban) infusions were started in the catheterization laboratory according to the coronary thrombus burden; tirofiban was not administered to patients who did not have coronary thrombus burden. All patients with small, moderate, or large thrombus burden received tirofiban therapy. The primary study endpoint was the incidence of all-cause mortality. The secondary study endpoints were major bleeding and MACE, which included all-cause death, nonfatal acute coronary syndrome, and target lesion revascularization. The patients were followed up for a mean period of 28.3±10.4 months. The groups showed similar in-hospital and long-term event rates (MACE, major bleeding, and all-cause mortality). The 3-year Kaplan-Meier overall survivals for no thrombus, small thrombus, moderate thrombus, and large thrombus were 91.9, 92.6, 92.3, and 89.5%, respectively. Despite the fact that the large coronary thrombus was found to be a predictor of MACE and mortality in many previous studies, we found that the large thrombus was not associated with MACE or in-hospital mortality or long-term mortality. This can be an effect of downstream GPI therapy. We suggest the use of downstream GPI therapy for STEMI patients with large coronary thrombus without an increased risk of bleeding.