Highlights
- •Approximate 40% cardioembolic stroke patients treated with EVT received tirofiban.
- •Low-dose tirofiban is not associated with symptomatic intracerebral hemorrhage.
- •In-hospital mortality was significantly lower in patients receiving low-dose tirofiban.
Abstract
Background and purpose
Whether tirofiban is safe and effective in cardioembolic stroke patients treated with
endovascular thrombectomy (EVT) remains unknown; this study evaluated the safety and
efficacy of low-dose tirofiban in this patients population.
Methods
This study was a prospective registry study. Patients with cardioembolic stroke undergoing
EVT from January 2013 to December 2020 were treated with EVT alone or EVT plus low-dose
tirofiban. The primary outcome was symptomatic intracerebral hemorrhage (sICH) prior
to discharge. The secondary outcomes included reocclusion, in-hospital mortality,
and 3-month functional outcomes.
Results
Overall, 288 patients were recruited and 117 received low-dose tirofiban; 137 patients
(47.6%) experienced ICH, 42 patients (14.6%) were sICH, and 23 patients (8%) were
fatal ICH. Thirteen patients (11.1%) receiving tirofiban and 29 patients (17.0%) not
receiving tirofiban experienced sICH (p = 0.167). Reocclusion occurred in nine patients (7.7%) receiving tirofiban and 15
patients (8.8%) not receiving tirofiban (p = 0.745). The rates of hernia (6.8% versus 20.5%) and decompressive craniectomy (2.6%
versus 11.7%) were significantly lower in patients receiving tirofiban (p < 0.01). At 3-month follow-up, functional independence was achieved in 39 patients(33.3%)
receiving tirofiban and 43 patients (25.1%) not receiving tirofiban (p = 0.131). Tirofiban was associated with lower odds of in-hospital mortality (3.4%
versus 12.3%; adjusted odds ratio, 0.16; 95% confidence interval, 0.03–0.81; adjusted
p = 0.027).
Conclusions
In patients with cardioembolic stroke undergoing EVT, tirofiban is not associated
with higher sICH, it seems to lead to lower odds of in-hospital death. Further investigations
are needed to confirm these results and to determine the optimal treatment protocols
of tirofiban.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mechanical thrombectomy for emergent large vessel occlusion: a critical appraisal of recent randomized controlled clinical trials.Brain Behav. 2016; 6e00418
- Safety and efficacy of solitaire stent thrombectomy: individual patient data meta-analysis of randomized trials.Stroke. 2016; 47: 798-806
- Vessel wall signal enhancement on 3-T MRI in acute stroke patients after stent retriever thrombectomy.Neurosurg. Focus. 2017; 42E20
- Safety and efficacy of tirofiban in acute ischemic stroke patients receiving endovascular treatment: a meta-analysis.Cerebrovasc. Dis. 2020; 49: 442-450
- Local tirofiban infusion for remnant stenosis in large vessel occlusion: tirofiban ASSIST study.BMC Neurol. 2020; 20: 284
- Efficacy and safety of low-dose tirofiban for acute intracranial atherosclerotic stenosis related occlusion with residual stenosis after endovascular treatment.J. Stroke Cerebrovasc. Dis. 2020; 29: 104619
- Stroke in Asia: geographical variations and temporal trends.J. Neurol. Neurosurg. Psychiatry. 2014; 85: 1308-1312
- Cardioembolic stroke: an update.Lancet Neurol. 2003; 2: 177-188
- Safety and efficacy of tirofiban combined with endovascular therapy compared with endovascular therapy alone in acute ischemic stroke: a meta-analysis.Neuroradiology. 2021; 63: 17-25
- Low-dose tirofiban improves functional outcome in acute ischemic stroke patients treated with endovascular thrombectomy.Stroke. 2017; 48: 3289-3294
- Endovascular stroke therapy: tirofiban is associated with risk of fatal intracerebral hemorrhage and poor outcome.Stroke. 2013; 44: 1453-1455
- Long-term outcomes of acute ischemic stroke patients treated with endovascular thrombectomy: a real-world experience.J. Neurol. Sci. 2018; 390: 77-83
- Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of org 10172 in Acute Stroke Treatment.Stroke. 1993; 24: 35-41
- Accuracy of serial National Institutes of Health Stroke Scale scores to identify artery status in acute ischemic stroke.Circulation. 2007; 115: 2660-2665
- Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke programme Early CT Score.Lancet. 2000; 355: 1670-1674
- Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.N. Engl. J. Med. 2008; 359: 1317-1329
- The Heidelberg bleeding classification classification of bleeding events after ischemic stroke and reperfusion therapy.Stroke. 2015; 46: 2981-2986
- Primer of Applied Regression and Analysis of Variance.Primer of Applied Regression & Analysis of Variance, 1990
- Predicting symptomatic intracranial haemorrhage after mechanical thrombectomy: the TAG score.J. Neurol. Neurosurg.: Psychiatry. 2019; 90: 1370-1374
- Platelet glycoprotein IIb/IIIa receptor inhibitor tirofiban in acute ischemic stroke.Drugs. 2019; 79: 515-529
- Safety and efficacy of tirofiban combined with mechanical thrombectomy depend on ischemic stroke etiology.Front. Neurol. 2019; 10: 1100
- Safety of intra-arterial tirofiban administration in ischemic stroke patients after unsuccessful mechanical thrombectomy.J. Vasc. Interv. Radiol. : JVIR. 2019; 30 (141-7.e1)
- Intracranial hemorrhage after reperfusion therapies in acute ischemic stroke patients.Front. Neurol. 2020; 11: 599908
- Reduced microvascular thrombosis and improved outcome in acute murine stroke by inhibiting GP IIb/IIIa receptor-mediated platelet aggregation.J. Clin. Investig. 1998; 102: 1301
Article info
Publication history
Published online: June 14, 2021
Accepted:
June 11,
2021
Received in revised form:
May 24,
2021
Received:
April 12,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V.
