1
|
Sun Z, Huang S, Li W, Yang Y, Wu Y, Ma X, Nie X, Jin W, Liu C, Li X, Xu Y, Dong J, Liao Y, Sun B, Han W, Zhao Q, Chi H, Wang Y, Liu L, Zhang M. Preoperative and intraoperative tirofiban during endovascular thrombectomy in large vessel occlusion stroke due to large artery atherosclerosis. Eur J Neurol 2024; 31:e16419. [PMID: 39072930 DOI: 10.1111/ene.16419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/27/2024] [Accepted: 07/09/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND PURPOSE The aim of this study is to investigate the efficacy and safety of preoperative versus intraoperative tirofiban in patients with large vessel occlusion (LVO) due to large artery atherosclerosis (LAA). METHODS This is a retrospective multicenter cohort study based on the RESCUE-RE (Registration Study for Critical Care of Acute Ischemic Stroke After Recanalization) trial enrolling patients with anterior circulation LVO classified as LAA within 24 h of onset. Patients were divided into three groups: preoperative tirofiban (PT), intraoperative tirofiban (IT), and no tirofiban (NT). Propensity score matching (PSM) was used to balance baseline characteristics. The efficacy outcomes included 90-day functional independence (modified Rankin Scale score = 0-2) and early partial recanalization (EPR; defined as a modified Thrombolysis in Cerebral Infarction score = 1-2a). The safety outcomes included symptomatic intracranial hemorrhage (sICH). RESULTS A total of 104 matched triplets were obtained through PSM. Compared with NT, PT increased 90-day functional independence (60.8% vs. 42.3%, p = 0.008) and EPR (42.7% vs. 18.3%, p < 0.001) rate, with a tendency to increase the asymptomatic intracranial hemorrhage (aICH) proportion (28.8% vs. 18.3%, p = 0.072). Compared with IT, PT had a higher 90-day functional independence (60.8% vs. 45.2%, p = 0.025) and EPR (42.7% vs. 20.2%, p = 0.001) rate, with no significant difference in sICH (14.4% vs. 7.7%, p = 0.122) and aICH (28.8% vs. 21.2%, p = 0.200). Compared with NT, IT had a lower 90-day mortality rate (9.6% vs. 24.0%, p = 0.005). CONCLUSIONS Tirofiban shows good adjuvant therapy potential in acute ischemic stroke-LVO due to LAA patients. PT is associated with higher rates of EPR and better therapeutic efficacy. In addition, EPR may be a potential way to improve prognosis.
Collapse
Affiliation(s)
- Zhiqiang Sun
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Shuhan Huang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Li
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yi Yang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ya Wu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xue Ma
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Ximing Nie
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wangsheng Jin
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Chengchun Liu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xiaoshu Li
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yaning Xu
- Department of Neurology, 985 Hospital of Joint Logistics Support Force, Taiyuan, China
| | - Jun Dong
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yisi Liao
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Binlu Sun
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wenjun Han
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Qing Zhao
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Huaqiao Chi
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Yanjiang Wang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Meng Zhang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, China
| |
Collapse
|
2
|
Xu D, Yang C, Cao W, Zhang X, Yang S, Shen X, Xu J, Yu H. Platelet glycoprotein IIb/IIIa antagonists in ischemic stroke patients without endovascular therapy: A meta-analysis. Pharmacotherapy 2024; 44:675-691. [PMID: 38949433 DOI: 10.1002/phar.2949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 05/20/2024] [Accepted: 05/22/2024] [Indexed: 07/02/2024]
Abstract
Platelet glycoprotein (GP) IIb/IIIa antagonists have been employed in selective patients after endovascular therapy (EVT) for acute ischemic stroke (AIS), yet application in patients without EVT is debated. This meta-analysis of randomized controlled studies on AIS patients without EVT assessed the effectiveness and safety of platelet GP IIb/IIIa antagonists compared with traditional antiplatelet or thrombolysis therapy. Articles were retrieved from databases, including PubMed, Web of Science, EMBASE, and Cochrane. The risk of bias and certainty level of evidence were assessed. Fifteen studies were included. GP IIb/IIIa antagonists increased the proportion of patients with modified Rankin Scale (mRS) 0-1 (odd ratio [OR] 1.37, 95% confidence interval [CI] 1.04-1.81, p = 0.03), mRS 0-2 (OR 1.27, 95% CI 1.12-1.46, p = 0.0004), and Barthel Index (BI) 95-100 (OR 1.25, p = 0.005); decreased the proportion of stroke progression within 5 days (OR 0.66, p = 0.006); and lowered the mean mRS score at 90 days (mean difference [MD] -0.43, p = 0.002) and the National Institute of Health stroke scale score at 7 days (MD -1.64, p < 0.00001) compared with conventional treatment. Proportions of stroke recurrence within 90 days (OR 1.20, p = 0.60), any intracranial hemorrhage (aICH) (OR 1.20, p = 0.12), symptomatic intracranial hemorrhage (sICH) (OR 0.91, p = 0.88), and death (OR 0.87, p = 0.25) had no statistical difference between both groups. This meta-analysis finds that compared with traditional antiplatelet or thrombolysis therapy, GP IIb/IIIa antagonists administered within 24-96 h of ischemic stroke onset significantly improve functional prognosis of patients with AIS not receiving EVT, as indicated by mRS and BI at 90 days, and do not increase the incidence of aICH, sICH, and death.
Collapse
Affiliation(s)
- Dongjun Xu
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Cheng Yang
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Wei Cao
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Xinyu Zhang
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Shucong Yang
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Xuning Shen
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Jun Xu
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| | - Huijie Yu
- Department of Emergency Medicine, The First Hospital of Jiaxing, Jiaxing University, Jiaxing, China
| |
Collapse
|
3
|
Zhao W, Li S, Li C, Wu C, Wang J, Xing L, Wan Y, Qin J, Xu Y, Wang R, Wen C, Wang A, Liu L, Wang J, Song H, Feng W, Ma Q, Ji X. Effects of Tirofiban on Neurological Deterioration in Patients With Acute Ischemic Stroke: A Randomized Clinical Trial. JAMA Neurol 2024; 81:594-602. [PMID: 38648030 PMCID: PMC11036313 DOI: 10.1001/jamaneurol.2024.0868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/23/2024] [Indexed: 04/25/2024]
Abstract
Importance Evidence supports using antiplatelet therapy in patients with acute ischemic stroke. However, neurological deterioration remains common under the currently recommended antiplatelet regimen, leading to poor clinical outcomes. Objective To determine whether intravenous tirofiban administered within 24 hours of stroke onset prevents early neurological deterioration in patients with acute noncardioembolic stroke compared with oral aspirin. Design, Setting, and Participants This investigator-initiated, multicenter, open-label, randomized clinical trial with blinded end-point assessment was conducted at 10 comprehensive stroke centers in China between September 2020 and March 2023. Eligible patients were aged 18 to 80 years with acute noncardioembolic stroke within 24 hours of onset and had a National Institutes of Health Stroke Scale (NIHSS) score of 4 to 20. Intervention Patients were assigned randomly (1:1) to receive intravenous tirofiban or oral aspirin for 72 hours using a central, web-based, computer-generated randomization schedule; all patients then received oral aspirin. Main Outcome The primary efficacy outcome was early neurological deterioration (increase in NIHSS score ≥4 points) within 72 hours after randomization. The primary safety outcome was symptomatic intracerebral hemorrhage within 72 hours after randomization. Results A total of 425 patients were included in the intravenous tirofiban (n = 213) or oral aspirin (n = 212) groups. Median (IQR) age was 64.0 years (56.0-71.0); 124 patients (29.2%) were female, and 301 (70.8%) were male. Early neurological deterioration occurred in 9 patients (4.2%) in the tirofiban group and 28 patients (13.2%) in the aspirin group (adjusted relative risk, 0.32; 95% CI, 0.16-0.65; P = .002). No patients in the tirofiban group experienced intracerebral hemorrhage. At 90-day follow-up, 3 patients (1.3%) in the tirofiban group and 3 (1.5%) in the aspirin group died (adjusted RR, 1.15; 95% CI, 0.27-8.54; P = .63), and the median (IQR) modified Rankin scale scores were 1.0 (0-1.25) and 1.0 (0-2), respectively (adjusted odds ratio, 1.28; 95% CI, 0.90-1.83; P = .17). Conclusions and Relevance In patients with noncardioembolic stroke who were seen within 24 hours of symptom onset, tirofiban decreased the risk of early neurological deterioration but did not increase the risk of symptomatic intracerebral hemorrhage or systematic bleeding. Trial Registration ClinicalTrials.gov Identifier: NCT04491695.
Collapse
Affiliation(s)
- Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sijie Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Stroke Center, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Junmei Wang
- Department of Neurology, Ordos Central Hospital, Ordos, Inner Mongolia, China
| | - Lifei Xing
- Department of Neurology, Sinopharm North Hospital, Baotou, Inner Mongolia, China
| | - Yue Wan
- Department of Neurology, The Third People’s Hospital of Hubei Province, Wuhan, Hubei, China
| | - Jinhui Qin
- Department of Neurology, Nanyang Second People’s Hospital, Nanyang, Henan, China
| | - Yaoming Xu
- Department of Neurology, Tongliao City Hospital, Tongliao, Inner Mongolia, China
- Department of Neurology, Affiliated Hospital of Inner Mongolia Minzu University, Inner Mongolia, China
| | - Ruixian Wang
- Department of Neurology, Traditional Chinese Medicine Hospital of Tianjin Beichen District, Tianjin, China
- Department of Neurology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Changming Wen
- Department of Neurology, Nanyang Central Hospital, Nanyang, Henan, China
| | - Aihua Wang
- Department of Neurology, Qianfo Mountain Hospital of Shandong University, Jinan, China
| | - Lan Liu
- School of Statistics, University of Minnesota at Twin Cities, Minneapolis
| | - Jing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, North Carolina
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
4
|
Guo ZN, Zhang KJ, Zhang P, Qu Y, Abuduxukuer R, Nguyen TN, Chen HS, Yang Y. Early tirofiban administration after intravenous thrombolysis in acute ischemic stroke (ADVENT): Study protocol of a multicenter, randomized, double-blind, placebo-controlled clinical trial. Eur Stroke J 2024; 9:510-514. [PMID: 38196129 PMCID: PMC11318417 DOI: 10.1177/23969873231225069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Nearly half of patients with acute ischemic stroke who undergo intravenous thrombolysis (IVT) fail to achieve excellent functional outcomes. Early administration of tirofiban after IVT may improve patient outcomes. OBJECTIVE To evaluate the efficacy and safety of early tirofiban administration after intravenous tenecteplase in patients with acute ischemic stroke. METHODS AND DESIGN The ADVENT trial is a multicenter, randomized, parallel-controlled, double-blind clinical trial. A total of 1084 patients undergoing IVT without subsequent endovascular treatment will be recruited from multiple hospitals in China. Subjects will be randomized in a 1:1 ratio to receive tirofiban or placebo, which will be infused within 6 h after IVT until 24 h after IVT, at 0.4 μg/kg/min for 30 min and then at 0.1 μg/kg/min. The primary efficacy outcome is the proportion of patients with excellent functional outcomes (modified Rankin Scale (mRS) ⩽ 1) at 90 days. Secondary outcomes include the proportion of patients with favorable functional outcomes (mRS ⩽ 2) at 90 days and neurological functional assessments evaluated during hospitalization. Symptomatic intracranial hemorrhage will be the primary safety outcome. Mortality and other adverse events will be recorded. DISCUSSION This pivotal trial will provide important data on the early administration of antiplatelet therapy after IVT and may promote progress in treatment standards. TRIAL REGISTRY ClinicalTrials.gov (NCT06045156).
Collapse
Affiliation(s)
- Zhen-Ni Guo
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Neuroscience Research Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Ke-Jia Zhang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Peng Zhang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yang Qu
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Reziya Abuduxukuer
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Thanh N Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
| | - Yi Yang
- Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
5
|
Zhang J, Huang X, Wang G, Wang X, Zhang T, Wang D, Qi L, Liang J, Li B, Chu J, Li K, Sun L, Song Y, Zhao W, Zheng M, Meng Y, Yin H, Wang W, Han J. Efficacy and Safety of Tirofiban Before Stenting for Symptomatic Intracranial Atherosclerotic Stenosis: A Randomized Clinical Trial. Neurology 2024; 102:e209217. [PMID: 38489544 DOI: 10.1212/wnl.0000000000209217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/21/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Acute stent thrombosis (AST) is not uncommon and even catastrophic during intracranial stenting angioplasty in patients with symptomatic high-grade intracranial atherosclerotic stenosis (ICAS). The purpose of this study was to investigate whether adjuvant intravenous tirofiban before stenting could reduce the risk of AST and periprocedural ischemic stroke in patients receiving stent angioplasty for symptomatic ICAS. METHODS A prospective, multicenter, open-label, randomized clinical trial was conducted from September 9, 2020, to February 18, 2022, at 10 medical centers in China. Patients intended to receive stent angioplasty for symptomatic high-grade ICAS were enrolled and randomly assigned to receive intravenous tirofiban or not before stenting in a 1:1 ratio. The primary outcomes included the incidence of AST within 30 minutes after stenting, periprocedural new-onset ischemic stroke, and symptomatic intracranial hemorrhage. The outcomes were analyzed using logistic regression analysis to obtain an odds ratio and 95% confidence interval. RESULTS A total of 200 participants (122 men [61.0%]; median [interquartile ranges] age, 57 [52-66] years) were included in the analysis, with 100 participants randomly assigned to the tirofiban group and 100 participants to the control (no tirofiban) group. The AST incidence was lower in the tirofiban group than that in the control group (4.0% vs 14.0%; adjusted odds ratio, 0.25; 95% CI 0.08-0.82; p = 0.02). No significant difference was observed in the incidence of periprocedural ischemic stroke (7.0% vs 8.0%; p = 0.98) or symptomatic intracranial hemorrhage between the 2 groups. DISCUSSION This study suggests that adjuvant intravenous tirofiban before stenting could lower the risk of AST during stent angioplasty in patients with symptomatic high-grade ICAS. TRIAL REGISTRATION INFORMATION URL: chictr.org.cn; Unique identifier: ChiCTR2000031935. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that for patients with symptomatic high-grade ICAS, pretreatment with tirofiban decreases the incidence of acute stent thrombosis. This study is Class II due to the unequal distribution of involved arteries between the 2 groups.
Collapse
Affiliation(s)
- Jun Zhang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Xin Huang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Guoqing Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Xianjun Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Tao Zhang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Dong Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Lifeng Qi
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Jiye Liang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Bing Li
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Jianfeng Chu
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Kai Li
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Lili Sun
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Yun Song
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Wei Zhao
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Meimei Zheng
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Yao Meng
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Hao Yin
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Wei Wang
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| | - Ju Han
- From the Departments of Neurology (J.Z., L.S., Y.S., W.Z., M.Z., Y.M., H.Y., W.W., J.H.) and Clinical Pharmacy (X.H.), The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan; Department of Neurology (G.W.), Binzhou People's Hospital; Department of Neurology (X.W.), Linyi People's Hospital; Department of Neurology (T.Z.), The First Hospital of Zibo; Department of Neurology (D.W.), Weifang Hospital of Traditional Chinese Medicine; Department of Neurology (L.Q.), Liaocheng People's Hospital; Department of Neurology (J.L.), Yucheng People's Hospital, Dezhou; Department of Neurology (B.L.), Yantai Yuhuangding Hospital; Department of Neurology (J.C.), Jining First People's Hospital; and Department of Neurology (K.L.), Heze Municipal Hospital, China
| |
Collapse
|
6
|
Wang J, Li S, Li C, Wu C, Song H, Ma Q, Ji X, Zhao W. Safety and efficacy of tirofiban in preventing neurological deterioration in acute ischemic stroke (TREND): Protocol for an investigator-initiated, multicenter, prospective, randomized, open-label, masked endpoint trial. Brain Circ 2024; 10:168-173. [PMID: 39036300 PMCID: PMC11259324 DOI: 10.4103/bc.bc_93_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Antithrombotic therapy prevents adverse ischemic events following acute ischemic stroke (AIS). Intravenous tirofiban provides desirable antiplatelet effects, especially in patients who are vulnerable to neurological deterioration (ND). AIM The aim of the study was to test the hypothesis that intravenous administration of tirofiban, initiated within 24 h of ictus and continued for consecutive 72 h, would be more effective than aspirin in reducing the risk of ND within 72 h of enrollment among patients with potentially atherothrombotic ischemic stroke. METHODS The Safety and Efficacy of Tirofiban in Preventing Neurological Deterioration in Acute Ischemic Stroke (TREND) trial is an investigator-initiated, multicenter, prospective, randomized, open-label, masked endpoint study. Its eligibility criteria included AIS secondary to potential atherosclerosis, a National Institutes of Health Stroke Scale (NIHSS) score ranging from 4 to 20 points, ineligibility for recanalization therapy, and administration within 24 h postsymptom onset. Randomization was performed at a 1:1 ratio to allocate 420 patients into two groups to receive an intravenous tirofiban bridge to oral antiplatelet drugs or direct oral antiplatelet drugs. OUTCOMES The primary outcome is the proportion of patients with a ≥4-point increase in NIHSS score within 72 h of intervention compared to the score at enrollment. The key secondary outcomes include changes in NIHSS score, modified Rankin scale (mRS) score at 90 days, and dichotomized mRS scores (0-2 vs. 3-6 and 0-1 vs. 2-6) at 90 days. The safety variables are symptomatic intracerebral hemorrhage, any intracerebral hemorrhage, and systemic hemorrhage within 72 h after randomization and 90-day mortality. CONCLUSIONS The TREND trial may identify the suitability of intravenous tirofiban as a routine clinical strategy to prevent ND in patients with AIS within 24 h of the onset of symptoms. TRIAL REGISTRATION http://www.clinicaltrials.gov (identifier: NCT04491695).
Collapse
Affiliation(s)
- Jing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sijie Li
- Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | | |
Collapse
|
7
|
Liao X, Feng S, Wang Y, Pan Y, Chen W, Qu H, Zhao X, Liu L, Wang Y, Wang Y. Tirofiban combined with Aspirin in the Treatment of Acute Penetrating Artery Territory Infarction (STRATEGY): protocol for a multicentre, randomised controlled trial. Stroke Vasc Neurol 2024; 9:75-81. [PMID: 37220998 PMCID: PMC10956107 DOI: 10.1136/svn-2022-002284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/12/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Perforating artery territorial infarction (PAI) caused by branch atheromatous disease (BAD) is prone to recurrence and early progression without an effective and well-documented antiplatelet treatment regimen. Tirofiban, an adjunctive antiplatelet agent, has shown great potential to treat acute ischaemic stroke. However, whether the combination of tirofiban and aspirin can improve the prognosis of PAI remains unclear. AIM To explore an effective and safe antiplatelet regimen for reducing the risk of recurrence and early neurological deterioration (END) in PAI caused by BAD by comparing the tirofiban and aspirin combination with placebo and aspirin combination. METHODS Tirofiban combined with Aspirin in the Treatment of Acute Penetrating Artery Territory Infarction (STRATEGY) trial is an ongoing multicentre, randomised, placebo-controlled trial in China. Eligible patients shall be randomly assigned to receive standard aspirin with tirofiban or placebo on the first day and standard aspirin from days 2 to 90. The primary endpoint is a new stroke or END within 90 days. The primary safety endpoint is severe or moderate bleeding within 90 days. DISCUSSION The STRATEGY trial will assess whether tirofiban combined with aspirin is effective and safe in preventing recurrence and END in patients with PAI. TRIAL REGISTRATION NUMBER NCT05310968.
Collapse
Affiliation(s)
- Xiaoling Liao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing TiantanHospital, Capital Medical University, Beijing, China
| | - Shuo Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing TiantanHospital, Capital Medical University, Beijing, China
| | - Yicong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing TiantanHospital, Capital Medical University, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing TiantanHospital, Capital Medical University, Beijing, China
| | - Weiqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing TiantanHospital, Capital Medical University, Beijing, China
| | - Hui Qu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing TiantanHospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing TiantanHospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing TiantanHospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing TiantanHospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing TiantanHospital, Capital Medical University, Beijing, China
- Chinese Institute for Brain Research, Beijing, China
- National Center for Neurological Diseases, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
- Beijing Laboratory of Oral Health, Capital Medical University, Beijing, China
| |
Collapse
|
8
|
Cho KC, Son NH, Gwon SH, Choi JW, Jung WS. The safety and efficacy of intra-arterial low-dose tirofiban administration during endovascular therapy in patients with large ischemic core volume. Sci Rep 2024; 14:3353. [PMID: 38336813 PMCID: PMC10858233 DOI: 10.1038/s41598-024-53715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to evaluate the safety and efficacy of intra-arterial (IA) administration of low- dose tirofiban during endovascular therapy in patients with large ischemic core volumes on initial brain CT. Patients were divided into two groups based on the use of IA tirofiban. We identified 87 patients (16 and 71 patients in the tirofiban and no-tirofiban groups, respectively) with acute ischemic stroke due to intracranial artery occlusion who underwent endovascular therapy with a low Alberta Stroke Program Early CT scores (2-5). Multivariate logistic regression analysis revealed no association between IA tirofiban administration and serious postprocedural hemorrhagic complications (adjusted odds ratio (aOR), 0.720; 95% confidence interval (CI) 0.099-5.219; p = 0.960), any radiologic hemorrhage (aOR 0.076; 95% CI 0.003-2.323; p = 0.139), or 3-month mortality (aOR, 0.087; 95% CI 0.005-1.501; p = 0.093). However, IA tirofiban was associated with a lower 90-day mRS score (aOR, 0.197; 95% CI 0.015-1.306; p = 0.017) and change of NIHSS compared with baseline (aOR, 0.698; 95% CI 0.531-0.917; p = 0.010). IA tirofiban administration during endovascular therapy in patients with large ischemic core volumes may be effective and safe.
Collapse
Affiliation(s)
- Kwang-Chun Cho
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu, South Korea
| | - So Hyeon Gwon
- Department of Statistics, Keimyung University, Daegu, South Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, South Korea
| | - Woo Sang Jung
- Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, South Korea.
| |
Collapse
|
9
|
Marei O, Podlasek A, Soo E, Butt W, Gory B, Nguyen TN, Appleton JP, Richard S, Rice H, de Villiers L, Carraro do Nascimento V, Domitrovic L, McConachie N, Lenthall R, Nair S, Malik L, Panesar J, Krishnan K, Bhogal P, Dineen RA, England TJ, Campbell BCV, Dhillon PS. Safety and efficacy of adjunctive intra-arterial antithrombotic therapy during endovascular thrombectomy for acute ischemic stroke: a systematic review and meta-analysis. J Neurointerv Surg 2024:jnis-2023-021244. [PMID: 38253378 DOI: 10.1136/jnis-2023-021244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Half of patients who achieve successful recanalization following endovascular thrombectomy (EVT) for acute ischemic stroke experience poor functional outcome. We aim to investigate whether the use of adjunctive intra-arterial antithrombotic therapy (AAT) during EVT is safe and efficacious compared with standard therapy (ST) of EVT with or without prior intravenous thrombolysis. METHODS Electronic databases were searched (PubMed/MEDLINE, Embase, Cochrane Library) from 2010 until October 2023. Data were pooled using a random-effects model and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using ROBINS-I and ROB-2. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes were successful recanalization (modified Thrombolysis In Cerebral Infarction (TICI) 2b-3), symptomatic intracranial hemorrhage (sICH), and 90-day mortality. RESULTS 41 randomized and non-randomized studies met the eligibility criteria. Overall, 15 316 patients were included; 3296 patients were treated with AAT during EVT and 12 020 were treated with ST alone. Compared with ST, patients treated with AAT demonstrated higher odds of functional independence (46.5% AAT vs 42.6% ST; OR 1.22, 95% CI 1.07 to 1.40, P=0.004, I2=48%) and a lower likelihood of 90-day mortality (OR 0.71, 95% CI 0.61 to 0.83, P<0.0001, I2=20%). The rates of sICH (OR 1.00, 95% CI 0.82 to 1.22,P=0.97, I2=13%) and successful recanalization (OR 1.09, 95% CI 0.84 to 1.42, P=0.52, I2=76%) were not significantly different. CONCLUSION The use of AAT during EVT may improve functional outcomes and reduce mortality rates compared with ST alone, without an increased risk of sICH. These findings should be interpreted with caution pending the results from ongoing phase III trials to establish the efficacy and safety of AAT during EVT.
Collapse
Affiliation(s)
- Omar Marei
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Anna Podlasek
- Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee, UK
| | - Emma Soo
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Waleed Butt
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Benjamin Gory
- Department of Diagnostic and Therapeutic Neuroradiology, CHRU de Nancy, Nancy, Lorraine, France
| | - Thanh N Nguyen
- Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- Radiology, Boston Medical Center Department of Radiology, Boston, Massachusetts, USA
| | - Jason P Appleton
- Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Stroke Trials Unit, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | | | - Hal Rice
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Laetitia de Villiers
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | | | - Luis Domitrovic
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Norman McConachie
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Robert Lenthall
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sujit Nair
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luqman Malik
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jasmin Panesar
- Interventional Neuroradiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kailash Krishnan
- Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Pervinder Bhogal
- Interventional Neuroradiology, Royal London Hospital, London, UK
| | - Robert A Dineen
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Timothy J England
- Stroke Trials Unit, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Stroke Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Bruce C V Campbell
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Permesh Singh Dhillon
- Radiological Sciences, Mental Health & Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Department of Interventional Neuroradiology, Gold Coast University Hospital, Southport, Queensland, Australia
| |
Collapse
|
10
|
Luo B, Yuan M, Kuang W, Wang Y, Chen L, Zhang Y, Chen G. A novel nomogram predicting early neurological deterioration after intravenous thrombolysis for acute ischemic stroke. Heliyon 2024; 10:e23341. [PMID: 38163222 PMCID: PMC10757001 DOI: 10.1016/j.heliyon.2023.e23341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/17/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Objectives Intravenous thrombolysis therapy (IVT) with recombinant tissue plasminogen activator has proven to be a beneficial treatment for acute ischemic stroke (AIS) patients when administered within 4.5 h after a stroke. This study aimed to investigate an available and inexpensive predictive tool for early neurological deterioration in AIS. Methods Patients admitted to our department with acute stroke who were given IVT with recombinant tissue plasminogen activator within 4.5 h of stroke onset were included in the study. The NIH stroke scale (NIHSS) was used to assess patients' neurological state prior to IVT and for 24 h after. Early neurological deterioration was defined as occurring if the NIHSS total score increased by ≥ 4 or the NIHSS individual score increased by ≥ 2 compared to baseline. Patients were randomly assigned to training or validation cohorts. Results Of the 266 AIS patients receiving IVT who were screened, 217 were deemed eligible for the study. Multivariate logistic regression analysis identified smoking history, NIHSS score, homocysteine level, and neutrophil to lymphocyte ratio as independent factors for predicting early neurological deterioration. ROC analysis was used to assess the quality of the resulting nomogram. The AUC for the training dataset was 0.826 (95 % CI, 0.719-0.932), and for the validation dataset was 0.887 (95 % CI, 0.763-1.000). Conclusion The robustness of this nomogram suggests that it may be a reliable tool for evaluating the progression of AIS after IVT.
Collapse
Affiliation(s)
- Bang Luo
- Department of Neurology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Mei Yuan
- Department of Neurology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Wending Kuang
- Department of Neurology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Yuzheng Wang
- Department of Neurology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Liucui Chen
- School of Pharmaceutical Science, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Yang Zhang
- Department of Neurology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| | - Gang Chen
- Department of Neurology, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, Hunan, 421001, China
| |
Collapse
|
11
|
Liu R, Liang Z, Li W, Zhan Y, Xu L, Yang S, Zheng G, Jiang L, Xie L, Sun Z, Hu Y. Adding Tirofiban on Top of Recombinant Tissue Plasminogen Activator May Improve Clinical Outcome in Acute Stroke Patients. J Stroke 2024; 26:121-124. [PMID: 38326710 PMCID: PMC10850455 DOI: 10.5853/jos.2023.02250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/26/2023] [Accepted: 11/02/2023] [Indexed: 02/09/2024] Open
Affiliation(s)
- Ruhui Liu
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
- The Second Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Zhigang Liang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Wei Li
- Department of Neurology, Beijing Tiantan Hospital affiliated to Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yan Zhan
- The Second Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Luyao Xu
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Shaowan Yang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Guomin Zheng
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
- The Second Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Li Jiang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
- The Second Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Liwen Xie
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
- The Second Clinical Medical College, Binzhou Medical University, Yantai, China
| | - Zhongwen Sun
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| | - Yinbao Hu
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai Regional Sub-Center of China National Clinical Research Center for Neurological Diseases, Yantai, China
| |
Collapse
|
12
|
Saigal K, Patel AB, Lucke-Wold B. Artificial Intelligence and Neurosurgery: Tracking Antiplatelet Response Patterns for Endovascular Intervention. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1714. [PMID: 37893432 PMCID: PMC10608122 DOI: 10.3390/medicina59101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/22/2023] [Accepted: 09/22/2023] [Indexed: 10/29/2023]
Abstract
Platelets play a critical role in blood clotting and the development of arterial blockages. Antiplatelet therapy is vital for preventing recurring events in conditions like coronary artery disease and strokes. However, there is a lack of comprehensive guidelines for using antiplatelet agents in elective neurosurgery. Continuing therapy during surgery poses a bleeding risk, while discontinuing it before surgery increases the risk of thrombosis. Discontinuation is recommended in neurosurgical settings but carries an elevated risk of ischemic events. Conversely, maintaining antithrombotic therapy may increase bleeding and the need for transfusions, leading to a poor prognosis. Artificial intelligence (AI) holds promise in making difficult decisions regarding antiplatelet therapy. This paper discusses current clinical guidelines and supported regimens for antiplatelet therapy in neurosurgery. It also explores methodologies like P2Y12 reaction units (PRU) monitoring and thromboelastography (TEG) mapping for monitoring the use of antiplatelet regimens as well as their limitations. The paper explores the potential of AI to overcome such limitations associated with PRU monitoring and TEG mapping. It highlights various studies in the field of cardiovascular and neuroendovascular surgery which use AI prediction models to forecast adverse outcomes such as ischemia and bleeding, offering assistance in decision-making for antiplatelet therapy. In addition, the use of AI to improve patient adherence to antiplatelet regimens is also considered. Overall, this research aims to provide insights into the use of antiplatelet therapy and the role of AI in optimizing treatment plans in neurosurgical settings.
Collapse
Affiliation(s)
- Khushi Saigal
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Anmol Bharat Patel
- College of Medicine, University of Miami—Miller School of Medicine, Miami, FL 33136, USA;
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
| |
Collapse
|
13
|
Al-Salihi MM, Ayyad A, Al-Jebur MS, Al-Salihi Y, Saha R, Morsi RZ, Kass-Hout T, Kasab SA, Spiotta AM. Safety and efficacy of tirofiban in the management of stroke: A systematic review and meta-analysis of randomized controlled trials. Clin Neurol Neurosurg 2023; 232:107867. [PMID: 37423089 DOI: 10.1016/j.clineuro.2023.107867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/01/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND About 30 % of stroke patients have experienced unsuccessful reperfusion following endovascular therapy. Mechanical thrombectomy instruments may contribute to this by stimulating platelet aggregation. Tirofiban is a selective and rapidly activated antagonist of the platelets nonpeptide glycoprotein IIb/IIIa receptors that can reversibly suppress platelet aggregation. But, data from the medical literature are conflicting regarding its safety and efficacy for stroke patients. Hence, this study was designed to assess the safety and efficacy of tirofiban in stroke patients. METHODS Five major databases (PubMed, Scopus, Web of Science, Embase, and Cochrane library) were searched till December 2022. The Cochrane tool was used for risk of bias assessment, and the RevMan 5.4 was utilized for data analysis. RESULTS Seven RCTs with 2088 stroke patients were included. Tirofiban significantly increased the number of patients with mRS 0 score after 90 days than control; RR= 1.39, 95 %CI [1.15, 1.69]; p = 0.0006. Additionally, it reduced the NIHSS score after seven days; MD= -0.60, 95 %CI [-1.14, -0.06]; p = 0.03. However, tirofiban increased the incidence of intracranial haemorrhage (ICH); RR= 1.22, 95 %CI [1.03, 1.44]; p = 0.02. Other assessed outcomes showed insignificant results. CONCLUSIONS Tirofiban was associated with a higher mRS 0 score after three months and a lower NIHSS score after seven days. However, it is associated with higher ICH. Multicentric trials are required to provide more convincing proof of its utility.
Collapse
Affiliation(s)
- Mohammed Maan Al-Salihi
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; College of Medicine/ University of Baghdad, Baghdad, Iraq; Department of Neurosurgery, Hamad General Hospital, Doha, Qatar.
| | - Ali Ayyad
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar; Department of Neurosurgery, Saarland University, Homburg, Germany
| | | | | | - Ram Saha
- Department of Neurology, Virginia Commonwealth University, VA, USA
| | - Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
14
|
Shang X, He C, Yang K, Guo Y, Zhou Z, Zi W. Effects of Antecedent Intravenous Thrombolysis on Endovascular Treatment of Acute Stroke Using Tirofiban. J Vasc Interv Radiol 2023; 34:420-426. [PMID: 36509235 DOI: 10.1016/j.jvir.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate whether preceding intravenous thrombolysis combined with tirofiban in patients with acute ischemic stroke undergoing endovascular treatment is safe and effective. MATERIALS AND METHODS Consecutive data were identified for patients who experienced acute ischemic stroke and were admitted to 2 comprehensive stroke centers from January 2015 to August 2021. All patients were divided into 2 groups-a thrombolytic with tirofiban group and a tirofiban-alone group-on the basis of whether intravenous thrombolysis before emergency endovascular angioplasty was used. Multivariate regression and propensity adjustment analyses were performed to characterize differences in safety and clinical outcomes between the 2 groups. RESULTS Of 373 eligible patients, 111 (29.7%) were treated with thrombolysis with tirofiban. There was a significant difference in the rate of any intracerebral hemorrhage (35.1% vs 24.8%; P = .04) but not in the rates of symptomatic intracerebral hemorrhage (16.2% vs 11.5%; P = .23) and reocclusion at 24 hours (5.4% vs 7.6%; P = .51) between the 2 groups. Multivariate regression analysis revealed that intravenous thrombolysis was not associated with any or symptomatic intracerebral hemorrhage, artery occlusion, functional outcome, or death at the 3-month follow-up (all adjusted P > .05). After propensity adjustment, the thrombolytic with tirofiban group showed nonsignificant rates of clinical and safety outcomes compared with those of the tirofiban-alone group (all P > .05). CONCLUSIONS Tirofiban may be used without increasing the risk of adverse events in selected patients who experienced ischemic stroke and were treated with intravenous thrombolysis and endovascular therapy.
Collapse
Affiliation(s)
- Xianjin Shang
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Caifeng He
- Department of Dermatology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Ke Yang
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Yapeng Guo
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Zhiming Zhou
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China.
| |
Collapse
|
15
|
Wang Y, Ma H, Zhang Q, Jin F, Xu Y, Ma Q, Ji X. Factors affecting the outcomes of tirofiban after endovascular treatment in acute ischemic stroke: Experience from a single center. CNS Neurosci Ther 2023; 29:957-967. [PMID: 36601660 PMCID: PMC9928549 DOI: 10.1111/cns.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/25/2022] [Accepted: 11/27/2022] [Indexed: 01/06/2023] Open
Abstract
AIMS To investigate the predicted factors influencing the outcomes in acute ischemic stroke (AIS) patients who received tirofiban after endovascular treatment (EVT) and the optimal administration of tirofiban. METHODS In this retrospective study, AIS patients who received EVT followed by tirofiban between January 2017 and October 2021 were enrolled. The dose and duration of tirofiban were adjusted by trained clinicians according to the patient's clinical status. A reduction of at least four points on the National Institutes of Health Stroke Scale (NIHSS) after tirofiban compared with that before tirofiban was defined as an effective response. A modified ranking scale (mRS) of 0-2 was defined as a favorable outcome at a 90-day follow-up. RESULTS A total of 260 consecutive patients were enrolled, and 36.5% of patients achieved a favorable outcome. The modified thrombolysis in cerebral infarction (mTICI) 2b-3 occurred in 93.5% of patients. Symptomatic intracerebral hemorrhage (sICH) occurred in 6.2% of patients, and the mortality at 90-day follow-up was 16.9%. Duration of tirofiban >24 h (adjusted OR: 2.545; 95% CI: 1.008-6.423; p = 0.048) and effective response to tirofiban (adjusted OR: 25.562; 95% CI: 9.794-66.715; p < 0.001) were related to the favorable outcome (mRS 0-2). Higher NIHSS (adjusted OR: 0.855; 95% CI: 0.809-0.904; p < 0.001) and glucose level on admission (adjusted OR: 0.843; 95% CI: 0.731-0.971; p = 0.018) were predictive for the unfavorable outcome (mRS 3-6). CONCLUSIONS An effective response to tirofiban is an independent factor in predicting the long-term efficacy outcome, and extending the duration of tirofiban is beneficial for neurological improvement.
Collapse
Affiliation(s)
- Yuan Wang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Hongrui Ma
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Qihan Zhang
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Feiyang Jin
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Yi Xu
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Qingfeng Ma
- Department of Neurology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu HospitalCapital Medical UniversityBeijingChina
| |
Collapse
|
16
|
Shi H, Hou MM, Ren G, He ZF, Liu XL, Li XY, Sun B. Tirofiban for Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis: A Systematic Review and Meta-Analysis. Cerebrovasc Dis 2022; 52:587-596. [PMID: 36580906 DOI: 10.1159/000527861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/22/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Tirofiban has been used as a rescue when thrombectomy is not successful in endovascular therapy (EVT) for acute ischemic stroke (AIS), but the use of tirofiban after intravenous thrombolysis (IVT) is controversial. The purpose of this meta-analysis was to evaluate the safety and efficacy of tirofiban combined with IVT in AIS compared with not receiving tirofiban. METHODS The PubMed and Embase databases were searched for all relevant studies published up to August 31, 2021. The safety endpoints included symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and mortality. The efficacy endpoint was the modified Rankin Scale (mRS) score at the 3-month follow-up. RESULTS Seven articles (1,036 patients) were included. Of these, 444 patients received tirofiban, and 592 patients did not. Meta-analysis showed that tirofiban did not increase the risk of sICH (OR 0.98; 95% CI 0.50-1.93; p = 0.96), any ICH (OR 0.94; 95% CI 0.63-1.39; p = 0.75) or mortality (OR 0.67; 95% CI 0.39-1.15; p = 0.15) and tended to be associated with a favorable functional outcome (OR 1.33; 95% CI 0.99-1.78; p = 0.06) in patients with AIS. Subgroup analysis showed that bridging therapy combined with tirofiban could reduce mortality (OR 0.47; 95% CI 0.23-0.98; p = 0.04). Tirofiban significantly improved the favorable functional outcome in patients with IVT only (non-EVT) (OR 1.98; 95% CI 1.30-3.02; p = 0.002). CONCLUSION Intravenous tirofiban could be safe for patients with AIS undergoing IVT, regardless of receiving EVT. Intravenous tirofiban may reduce mortality rates for patients undergoing bridging therapy. It also could increase the likelihood of a favorable functional outcome, especially for patients receiving IVT only.
Collapse
Affiliation(s)
- Heng Shi
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Third Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Miao-Miao Hou
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Gang Ren
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Ze-Fan He
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Xiao-Lei Liu
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| | - Xin-Yi Li
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
- Third Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Bo Sun
- Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China
| |
Collapse
|
17
|
Low-dose intravenous tirofiban infusion after endovascular recanalization for non-acute middle cerebral artery occlusion. Heliyon 2022; 8:e12354. [PMID: 36619459 PMCID: PMC9813718 DOI: 10.1016/j.heliyon.2022.e12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/18/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
Background and purpose Endovascular recanalization for patients with symptomatic non-acute middle cerebral artery occlusion still remines challenging. Postoperative treatment is still controversial. This study aims to investigate the safety and effectiveness of tirofiban after elective angioplasty in patients with non-acute middle cerebral artery occlusion related ischemic stroke. Methods Our study is a retrospective case series study of 48 stroke patients who received elective endovascular recanalization for middle cerebral artery occlusion. Patients who received EVT without hemorrhage were divided into 2 groups: those who did not receive intravenous tirofiban treatment (control group, n = 25); those who received continuous intravenous infusion of 0.2-0.3 mg/h tirofiban for 48 h after endovascular recanalization (intravenous tirofiban group, n = 23). Early reocclusion of treated arteries, symptomatic hemorrhage, and 90-day functional outcome of the 2 groups were compared. Results The 90-day mRS score and NIHSS score after endovascular recanalization showed no significantly different between the two groups. However, the rate of mRS score reverse (≥1) was significantly higher in the intravenous tirofiban group than the control (73.9% versus 24.0%, P = 0.001), and the rate of NIHSS score reverse (≥3) in the intravenous tirofiban group was also higher (43.5% verse 16.0%, P = 0.037). The rate of early reocclusion, symptomatic hemorrhage (4.3% versw 4%, P = 0.734), showed no difference between the two groups. Conclusions Low-dose intravenous tirofiban infusion (0.2-0.3 mg/h for 48 h) after endovascular treatment seems to be safe and potentially effective for non-acute middle cerebral artery occlusion patients.
Collapse
|
18
|
Zhong HL, Zhou TF, He YK, Li TX, Li ZS. Safety and efficacy of adjunct tirofiban treatment following mechanical thrombectomy for acute ischemic stroke patients with large vessel occlusion (LVO) resulting in successful reperfusion. Interv Neuroradiol 2022:15910199221138883. [PMID: 36358016 DOI: 10.1177/15910199221138883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND PURPOSE Tirofiban administration after mechanical thrombectomy (MT) remains controversial. This study aimed to investigate the efficacy and safety of adjunct tirofiban treatment following MT for acute ischemic stroke (AIS) patients with large vessel occlusion (LVO) that resulted in successful reperfusion on digital subtraction angiography (DSA). METHODS This retrospective study was conducted in Zhengzhou University University People's Hospital, an advanced stroke center in China. Consecutive patients with AIS who underwent endovascular therapy (EVT) were enrolled from June 2018 to January 2022. The safety endpoints were symptomatic intracerebral hemorrhage (sICH), total intracranial hemorrhage (ICH), and 3-month mortality. The efficacy endpoints were 3-month modified Rankin scale (mRS) score and 24-h neurological improvement. RESULTS A total of 145 consecutive patients with AIS who underwent MT were analyzed, of whom 51 (35.2%) patients were in the tirofiban group. There were 30 (20.7%) patients with sICH, 50 (34.5%) patients suffered from ICH within 24-h post-MT, and 47 (32.4%) dead at 3-month. Besides, 31 (21.4%) patients achieved excellent clinical outcomes (mRS, 0-1), and 24-h neurological improvement was found in 29 (20.0%) patients. No statistically significant differences were found in safety outcomes on sICH, total ICH, and 3-month mortality, as well as efficacy outcomes on 3-month mRS scores (0-1) and 24-h neurological improvement between the two groups (P > 0.05 for all). Additionally, tirofiban was associated with 3-month mRS scores of 0-2 (adjusted odds ratio (OR), 3.75; 95% confidence interval (CI), 1.41-10.02, P = 0.008). CONCLUSION Adjunct tirofiban treatment following MT for AIS patients with LVO that resulted in successful reperfusion on DSA was not correlated with the increased risk of safety endpoints on sICH, ICH, and 3-month mortality, and it may be associated with a lower 3-month mRS score.
Collapse
Affiliation(s)
- Hai-Long Zhong
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, 89632Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Teng-Fei Zhou
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, 89632Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Ying-Kun He
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, 89632Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Tian-Xiao Li
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, 89632Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Zhao-Shuo Li
- Department of Cerebrovascular Disease, Zhengzhou University People's Hospital, 89632Henan Provincial People's Hospital, Zhengzhou, Henan, China
| |
Collapse
|
19
|
Zhang Y, Wang J, Ma Z, Mu G, Liang D, Li Y, Qian X, Zhang L, Shen F, Zhang L, Yu J, Liu Y. Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis. Front Neurol 2022; 13:982684. [PMID: 36267890 PMCID: PMC9577296 DOI: 10.3389/fneur.2022.982684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Intravenous thrombolysis (IVT) is a standard procedure for the treatment of patients with acute ischemic stroke (AIS). Improving the therapeutic efficacy of IVT is an important task for neurologists. The aim of this study was to evaluate the efficacy and safety of early low-dose tirofiban treatment in AIS patients with early neurological deterioration (END) after IVT. Methods In this prospective and randomized pilot study, 73 AIS patients with END were recruited from a local hospital in China. Of these, 14 patients were treated with regular antiplatelet agents (aspirin plus clopidogrel) and 59 patients were treated with tirofiban within 24 h of IVT, followed by regular antiplatelet therapy. Neurological deficits and functional recovery were assessed with NIHSS and modified Rankin Scale (mRS) at 7 and 90 days. During the 90-day follow-up period, both hemorrhagic (e.g., intracerebral hemorrhage) and non-hemorrhagic (e.g., pneumonia) events were recorded. Results Treatment with tirofiban compared with regular antiplatelet therapy: (1) improved functional recovery of AIS patients to mRS (≤2) at both 7 and 90 days (odds ratios [ORs], 1.37 and 1.64; 95% confidence interval [CI], 1.16–1.61 and 1.26–2.12; P = 0.008 and < 0.001, respectively), and (2) reduced NIHSS scores from 11.14 ± 2.38 to 5.95 ± 3.48 at day 7 (P < 0.001) and from 8.14 ± 2.74 to 4.08 ± 3.50 at day 90 (P < 0.001). Tirofiban treatment did not increase the risk of hemorrhagic complications. Multivariate regression analysis showed that tirofiban treatment independently predicted a favorable functional outcome (P ≤ 0.001). Conclusion Early treatment with low-dose tirofiban in AIS patients with neurologic deterioration after IVT potentially improved functional recovery and attenuated neurologic deficits as early as 7 days and did not increase the risk of various hemorrhagic complications. However, the therapeutic efficacy of tirofiban treatment in END patients needs to be determined by future randomized clinical trials with a large study population. Clinical trial registration http://www.chictr.org.cn/, Identifier ChiCTR2200058513.
Collapse
Affiliation(s)
- Yan Zhang
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
- *Correspondence: Yan Zhang
| | - Jianliang Wang
- Department of Radiology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Zhaoxi Ma
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Guihua Mu
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Da Liang
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Yifan Li
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Xiaoyan Qian
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Luyuan Zhang
- Department of Scientific and Technological Talents, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Fang Shen
- Department of Outpatient, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Lei Zhang
- Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, China
| | - Jie Yu
- Department of Neurology, The Second People's Hospital of Kunshan, Kunshan, China
| | - Yang Liu
- Department of Neurology, Saarland University, Homburg, Germany
- Yang Liu
| |
Collapse
|
20
|
Liu Q, Lu X, Yang H, Deng S, Zhang J, Chen S, Shi S, Xun W, Peng R, Lin B, Li T, Pan L, Weng B. Early tirofiban administration for patients with acute ischemic stroke treated with intravenous thrombolysis or bridging therapy: Systematic review and meta-analysis. Clin Neurol Neurosurg 2022; 222:107449. [PMID: 36162161 DOI: 10.1016/j.clineuro.2022.107449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/24/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In the present systematic review and meta-analysis, we sought to compare the efficacy and safety of tirofiban administered in patients with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT) with or without mechanical thrombectomy (MT). METHODS We searched PubMed, Web of Science, Embase and the Cochrane Library for randomized clinical trials and observational studies published between 2001 and 2021 that provided outcomes of AIS patients who underwent IVT alone or IVT bridging with or without tirofiban. The primary outcome was the proportion of patients achieving a modified Rankin Scale (mRS) score of 0-2 at 90 days. The secondary outcomes included the rates of (1) an excellent outcome defined as a mRS score of 0 or 1 at 90 days, (2) any type of intracranial hemorrhage (ICH), (3) symptomatic intracranial hemorrhage (sICH), (4) mortality, and (5) successful recanalization. RESULTS We included 722 patients with IVT bridging therapy in 3 trials; there were 171 patients in the tirofiban group and 551 patients in the nontirofiban group. We included 846 patients with IVT alone in 7 studies; there were 471 patients in the tirofiban group and 375 patients in the nontirofiban group. The patients treated with tirofiban had a reduced risk of mortality compared to the patients treated without tirofiban during IVT bridging (OR, 0.46; 95 % CI, 0.24-0.89; p = 0.02), but no significant differences were found in safety outcomes on sICH, ICH, recanalization or efficacy outcomes on modified Rankin scale 0-2 (p > 0.05). Pooled results showed that tirofiban combined with IVT alone did not increase the risks of sICH, ICH or mortality but was significantly associated with excellent (OR, 2.68; 95 % CI, 1.58-4.55; P = 0.0003) and favorable (OR, 2.36; 95 % CI, 1.58-3.52; p < 0.0001) functional outcomes at 90 days. CONCLUSION In AIS patients who underwent IVT or bridging therapy, early administration of tirofiban may be effective and safe, but further studies are needed to confirm the efficacy.
Collapse
Affiliation(s)
- Qianqian Liu
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Xianfu Lu
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Hong Yang
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Shan Deng
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Jian Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Shijian Chen
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Shengliang Shi
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Weiquan Xun
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Rihong Peng
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Baoquan Lin
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Tao Li
- Department of Radiology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Liya Pan
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Baohui Weng
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| |
Collapse
|
21
|
Hu Y, Xiao Q, Shi Z, Hou Y, Chen Z, Cheng J, Li G. Safety and efficacy of low-dose and long-course tirofiban in large hemispheric infarction. Front Neurol 2022; 13:987859. [PMID: 36158948 PMCID: PMC9500446 DOI: 10.3389/fneur.2022.987859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background The clinical efficacy and safety of tirofiban in the treatment of large hemispheric infarction (LHI) remain controversial. Methods This 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). Results A 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). Conclusions Low-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.
Collapse
|
22
|
Li XQ, Cui Y, Wang XH, Chen HS. Early Antiplatelet for Minor Stroke following Thrombolysis (EAST): Rationale and Design. Int J Stroke 2022; 18:615-619. [PMID: 35899772 DOI: 10.1177/17474930221118900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early neurological deterioration (END) occurs in about 10% of patients after intravenous thrombolysis (IVT), and is related to poor outcome. In theory, early antiplatelet following IVT could reduce END by preventing re-occlusion and stroke progression, but current guidelines recommend starting antiplatelet treatment at 24 hours after IVT due to concerns about hemorrhagic transformation. Given higher risk of hemorrhagic transformation in severe stroke, we hypothesized that minor stroke patients following IVT can safely benefit from early antiplatelet treatment. AIMS To explore the efficacy and safety of early antiplatelet in minor stroke patients after IVT.Sample size estimates: A maximum of 1022 patients are required to test the superiority hypothesis with 80% power according to a two-side 0.05 level of significance, stratified by age, gender, history of stroke or transient ischemic attack, history of hypertension, history of diabetes mellitus, systolic blood pressure at admission, time from IVT to treatment, thrombolysis drug, stroke territory, and stroke etiology. DESIGN Early antiplatelet for minor stroke following thrombolysis is a prospective, double blinded, multicenter, randomized and placebo-controlled trial. Minor stroke patients within 6h following IVT are randomly assigned into experimental group and control group with the ratio of 1:1. The experimental group is orally administered with 300 mg clopidogrel and 100 mg aspirin, and control group with placebo. Subsequently, both groups received guideline-based antithrombotic treatment from 24 hours after IVT to 90 days. OUTCOME The primary efficacy endpoint is excellent functional outcome, defined as the modified Rankin Scale 0-1 at 90 days after randomization, while primary safety endpoint is symptomatic intracerebral hemorrhage, defined as National Institutes of Health Stroke Scale score increase ≥4 caused by intracranial hemorrhage within 36 hours after randomization. CONCLUSIONS The results of EAST will provide us powerful early antiplatelet evidence for minor stroke population following intravenous thrombolysis in clinical practice.
Collapse
Affiliation(s)
- Xiao-Qiu Li
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China 74643
| | - Yu Cui
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China 74643
| | - Xin-Hong Wang
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China 74643
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China 74643
| |
Collapse
|
23
|
Liang Z, Zhang J, Huang S, Yang S, Xu L, Xiang W, Zhang M. Safety and efficacy of low-dose rt-PA with tirofiban to treat acute non-cardiogenic stroke: a single-center randomized controlled study. BMC Neurol 2022; 22:280. [PMID: 35897006 PMCID: PMC9327332 DOI: 10.1186/s12883-022-02808-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE The recanalization rate after intravenous thrombolysis (IVT) is not enough and there is still the possibility of re-occlusion. We aim to investigate the effectiveness and safety of infusing tirofiban after IVT. METHODS We performed a prospective controlled study of 60 patients with acute non-cardiogenic ischemic stroke who were hospitalized in Yantai Yuhuangding Hospital from January 2018 to December 2019. The patients were divided into 2 groups: those who received tirofiban for 24 h after IVT (rt-PA + T group) and those who did not receive postprocedural intravenous tirofiban (rt-PA group). The rt-PA + T group received low-dose rt-PA (0.6 mg/kg). The rt-PA group received standard dose rt-PA (0.9 mg/kg). The main outcome measure were safety, included the symptomatic intracranial hemorrhage (sICH), any ICH, severe systemic bleeding, and mortality. The secondary outcome measure is curative efficacy which were evaluated by the 7d-NIHSS score and functional outcomes at 90 days. During hospitalization, the deterioration of neurological function was recorded. RESULTS All patients completed the follow-up with complete data, there were 30 patients in each of groups. The general characteristics between the two group patients had no statistically significant differences. Compared with the rt-PA + T group and the rt-PA group, in terms of safety, the rates of the sICH, severe systemic bleeding, and mortality in both groups were 0, and there was no statistically significant difference in the rates of any ICH between the two groups (10.0% vs. 3.3%, P = 0.306). In terms of efficacy, the rate of the early neurological deterioration events (END) was no statistical significance (0 vs. 6.6%, P = 0.246). There was no significant difference in the NIHSS score between the two groups before the IVT, and also at 24 h, however, the 7d-NIHSS score was lower in the rt-PA + T group compared with the rt-PA group (2.33 ± 1.85 vs. 4.80 ± 4.02, P = 0.004). At 90 days, 83.3% of patients in the rt-PA + T group had favorable functional outcomes compared with 60.0% of patients in the rt-PA group (P = 0.045). CONCLUSIONS Low-dose rt-PA combined with tirofiban in acute non-cardiogenic ischemic stroke did not increase the risk of ICH, and mortality, and it was associated with neurological improvement. TRIAL REGISTRATION The trial has been registered at the ChiCTR and identified as ChiCTR1800014666 (28/01/2018).
Collapse
Affiliation(s)
- Zhigang Liang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, 264000, Yantai, China. .,Present Address: Yantai Yuhuangding Hostipal Affiliated to Qingdao University, No. 20 Yuhuangding East Road, Zhifu District, Shandong Province, Yantai, China.
| | - Junliang Zhang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, 264000, Yantai, China
| | | | - Shaowan Yang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, 264000, Yantai, China
| | - Luyao Xu
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, 264000, Yantai, China
| | - Wei Xiang
- Department of Neurology, Yantai Yuhuangding Hospital Affiliated to Qingdao University, 264000, Yantai, China
| | - Manman Zhang
- Binzhou Medical University, 264003, Yantai, China
| |
Collapse
|
24
|
Bo C, Wang T, Hou C, Han J, Chen L, Zhang H, Wang L, Li H. Evolution of ischemic stroke drug clinical trials in mainland China from 2005 to 2021. CNS Neurosci Ther 2022; 28:1229-1239. [PMID: 35642775 PMCID: PMC9253749 DOI: 10.1111/cns.13867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background To assess the temporal changes in the characteristics of ischemic stroke drug clinical trials conducted in mainland China in 2005–2021. Methods A statistical analysis of registered clinical trials on ischemic stroke was performed using the platform of the Center for Drug Evaluation of China National Medical Products Administration, the Chinese Clinical Trial Registry, and ClinicalTrials.gov websites. Results From January 1, 2005 to August 1, 2021, a total of 384 registered drug clinical trials on ischemic stroke were identified in mainland China. Over time, the number of trials gradually increased each year, with a significant growth in 2014, from 16 in 2013 to 42 in 2014. Phase IV trials (31.8%) accounted for the majority, followed by phase II (16.4%), phase I (10.9%), and phase III (8.6%). In terms of sponsorship, the proportion of investigator‐initiated trials (IITs) (60.7%) was higher than industry‐sponsored trials (ISTs) (39.3%). Additionally, trials involving traditional Chinese medicines (TCMs) (36.2%) accounted for the largest proportion, followed by trials involving antithrombotic therapy (19.5%) and cerebral protection agents (16.7%). Furthermore, over the past 17 years, the number of leading drug clinical trial units for ischemic stroke in mainland China has continuously increased. The leading principal units from Beijing, Shanghai, Guangdong, Jiangsu, and Liaoning accounted for the majority of the trials (67.4%). Conclusion In the past 17 years, great progress has been made in the research and development (R&D) of drugs and clinical trials for ischemic stroke in mainland China. The most extensive progress was observed in TCMs, antithrombotic therapy, and cerebral protection agents. More clinical trials are needed to confirm whether the newly developed drugs can improve the clinical efficacy of ischemic stroke. Simultaneously, more pharmaceutical R&D efforts of innovative drugs are warranted.
Collapse
Affiliation(s)
- Chunrui Bo
- Department of Neurology, XuanWu Hospital, Capital Medical University, Beijing, China.,Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Beijing, China
| | - Tianqi Wang
- Department of Neurology, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Chengbei Hou
- Center for Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinming Han
- Department of Neurology, XuanWu Hospital, Capital Medical University, Beijing, China
| | - Lixia Chen
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Beijing, China
| | - Huixue Zhang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Beijing, China
| | - Lihua Wang
- Department of Neurology, The Second Affiliated Hospital, Harbin Medical University, Beijing, China
| | - Hongyan Li
- Department of Neurology, Department of General Surgery, China National Clinical Research Center for Geriatric Diseases, XuanWu Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
25
|
Mosconi MG, Paciaroni M, Ageno W. Investigational drugs for ischemic stroke: what's in the clinical development pipeline for acute phase and prevention? Expert Opin Investig Drugs 2022; 31:645-667. [PMID: 35486110 DOI: 10.1080/13543784.2022.2072725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Stroke is a leading cause of disability and mortality and its burden expected to increase. The only approved drug for acute ischemic stroke is the intravenous thrombolytic alteplase. The risk of bleeding complications is one of the reasons for the undertreatment of eligible patients. Numerous drugs are currently being developed to improve safety-efficacy. AREAS COVERED We reviewed literature from January 1st, 2000, to 15th January 2022 for the development and testing of novel drugs with the aim of targeting treatment at prevention of ischemic stroke: PubMed, MEDLINE, Google Scholar, and ClinicalTrial.gov. EXPERT OPINION The pathophysiology of ischemic stroke involves multiple pathways causing cerebral artery obstruction and brain tissue ischemia. Data suggest that tenecteplase is a more promising fibrinolytic agent with a superior efficacy-safety profile, compared to the currently approved alteplase. Current guidelines consider a short-term cycle of mannitol or hypertonic saline to be advisable in patients with space-occupying hemispheric infarction. Regarding primary and secondary prevention, research is primarily focused on identifying mechanisms to improve the safety-efficacy profile using a "hemostasis-sparing" approach. Further evaluation on those agents that have already shown promise for their risk/benefit profiles, would benefit greatly a neurologist's capacity to successfully prevent and treat ischemic stroke patients.
Collapse
Affiliation(s)
- Maria Giulia Mosconi
- Emergency and vascular medicine Stroke Unit University of Perugia, Perugia, Italy
| | - Maurizio Paciaroni
- Emergency and vascular medicine Stroke Unit University of Perugia, Perugia, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| |
Collapse
|
26
|
Han B, Ma T, Liu Z, Wu Y, Tan W, Sun S, Li X, Shao C, Tang D, Sun J. Efficacy and Safety of Tirofiban in Clinical Patients With Acute Ischemic Stroke. Front Neurol 2022; 12:785836. [PMID: 35211073 PMCID: PMC8860815 DOI: 10.3389/fneur.2021.785836] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/30/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Intravenous 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. METHODS Patients 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. RESULTS A 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. CONCLUSION Our 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 REGISTRATION http://www.chictr.org.cn/, identifier: ChiCTR2000031297.
Collapse
Affiliation(s)
- Bin Han
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Teng Ma
- Department of Neurology, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser Hospital), Qingdao, China
| | - Zhendong Liu
- Department of Neurology, Laixi People's Hospital, Laixi, China
| | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Weiwei Tan
- Department of Neurology, Pingdu People's Hospital, Pingdu, China
| | - Shaoyang Sun
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuemei Li
- Department of Neurology, Qingdao West Coast New Area Central Hospital, Qingdao, China
| | - Changyan Shao
- Department of Pharmacology, Feixian People's Hospital, Linyi, China
| | - Duyong Tang
- Department of Neurology, Pingdu Third People's Hospital, Pingdu, China
| | - Jinping Sun
- Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
- Department of Emergency Internal Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
- National Engineering and Technology Research Center of Chirality Pharmaceutical, Linyi, China
| |
Collapse
|
27
|
Lee JS, Lee SJ, Hong JM, Alverne FJAM, Lima FO, Nogueira RG. Endovascular Treatment of Large Vessel Occlusion Strokes Due to Intracranial Atherosclerotic Disease. J Stroke 2022; 24:3-20. [PMID: 35135056 PMCID: PMC8829471 DOI: 10.5853/jos.2021.01375] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Mechanical thrombectomy (MT) has become the gold-standard for patients with acute large vessel occlusion strokes (LVOS). MT is highly effective in the treatment of embolic occlusions; however, underlying intracranial atherosclerotic disease (ICAD) represents a therapeutic challenge, often requiring pharmacological and/or mechanical rescue treatment. Glycoprotein IIb/IIIa inhibitors have been suggested as the best initial approach, if reperfusion can be achieved after thrombectomy, with angioplasty and/or stenting being reserved for the more refractory cases. In this review, we focus on the therapeutic considerations surrounding the endovascular treatment of ICAD-related acute LVOS.
Collapse
Affiliation(s)
- Jin Soo Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Seong-Joon Lee
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | | | | | - Raul G. Nogueira
- Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, UPMC Stroke Institute, Pittsburg, PA, USA
- Correspondence: Raul G. Nogueira Department of Neurology and Neurosurgery, University of Pittsburg Medical Center, UPMC Stroke Institute, C-400 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA Tel: +1-412-647-8080 Fax: +1-412-647-8445 E-mail:
| |
Collapse
|
28
|
Chen W, Gong J, Song R, Liu J, Wang M, Zhang T, Sun H, Zhao Z, Liu Y, Zhu Q, Wang X. Efficacy and safety of direct balloon angioplasty in the treatment of large atherosclerotic stroke. Clin Neurol Neurosurg 2021; 211:107035. [PMID: 34826756 DOI: 10.1016/j.clineuro.2021.107035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Based on the unclear safety and effectiveness of direct balloon angioplasty as a first-line treatment for patients with acute ischemic stroke caused by large artery atherosclerosis (LAA), our paper would center on investigating the safety and effectiveness of this novel strategy. PATIENTS AND METHODS A consecutive series of acute ischemic stroke patients due to intracranial atherosclerosis and short thrombus who underwent thorough direct balloon angioplasty from October 2019 to March 2021 were enrolled. The primary end point included arterial recanalization (modified Thrombolysis in Cerebral Infarction [mTICI]: 2b-3), and 90-day functional independence (modified Rankin Scale[mRS]: 0-2). The secondary end point was symptomatic intracerebral hemorrhage (sICH) and perioperative restenosis and re-occlusion of offending vessel. RESULTS 68 patients were included. Mean time from onset to groin puncture was 342.5 min and 50 min for groin puncture to successful recanalization. 61 (89.7%) patients achieved successful recanalization and 41 (60.3%) acquired functional independence. 11 (16.0%) patients experienced ICH and only 3 (4.4%) for sICH. 8 (11.8%) patients developed symptomatic restenosis or re-occlusion within seven days after the operation. In addition, 16 (23.5%) patients received rescue stenting and 3 (18.8%) of this subgroup appeared immediate intra-stent thrombosis. CONCLUSION Direct balloon angioplasty may be a safe and effective method for the treatment of stroke caused by intracranial large arteriosclerosis occlusion.
Collapse
Affiliation(s)
- Wang Chen
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Jian Gong
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Rao Song
- Department of Cardiology, Linyi People's Hospital, Linyi, Shandong, China
| | - Ji Liu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Mengen Wang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Tongtong Zhang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Hongyang Sun
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Zhenyu Zhao
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Yan Liu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Qiyi Zhu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China
| | - Xianjun Wang
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong, China.
| |
Collapse
|
29
|
Liu J, Yang Y, Liu H. Efficacy outcomes and safety measures of intravenous tirofiban or eptifibatide for patients with acute ischemic stroke: a systematic review and meta-analysis of prospective studies. J Thromb Thrombolysis 2021; 53:898-910. [PMID: 34780001 DOI: 10.1007/s11239-021-02584-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 12/12/2022]
Abstract
To review the literature for randomized control trials (RCTs) and prospective cohort studies investigating the safety and efficacy of tirofiban and eptifibatide in patients with acute ischemic stroke (AIS). PubMed, Embase, and the Cochrane library were searched for available papers published up to September 2021. The efficacy was evaluated based on the 3-month favorable outcome [modified Rankin scale (mRS) = 0-1], functional outcome (mRS = 0-2), and the last available National Institutes of Health Stroke Scale (NIHSS) score measured in each study. Twelve studies (two RCTs and 10 prospective cohorts) and 2926 patients were included. Treatment with tirofiban or eptifibatide had no effects on the favorable outcome (RR = 1.09, 95% CI 0.89-1.35, P = 0.411), functional outcome (RR = 1.12, 95% CI 0.98-1.28, P = 0.010), and last available NIHSS (WMD = - 2.32, 95% CI - 5.14 to 0.50, P = 0.106), but might increase mortality (RR = 0.84, 95% CI 0.71-0.99, P = 0.121). The sensitivity analyses showed that the meta-analyses were robust. There was no significant publication bias. Tirofiban did not increase the risk of ICH (P = 0. 423) and sICH (P = 0. 990) but increased the risk of fatal ICH (RR = 3.59, 95% CI 1.62-7.96, P = 0.002). Thrombolysis/thrombectomy did not influence any of the outcomes. Adding tirofiban or eptifibatide to thrombolysis/thrombectomy was not significantly associated with a favorable outcome (mRS = 0-1) nor functional outcome (mRS = 0-2) in patients with AIS at 3 months, but might be associated with mortality, possibly due to fatal ICH. The NIHSS was also not significantly different between the intervention and control groups after treatments.
Collapse
Affiliation(s)
- Jingting Liu
- Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Yihong Yang
- Department of Emergency, Fuyang People's Hospital, Fuyang, 236000, China
| | - Hongbo Liu
- Department of Emergency, Fuyang People's Hospital, Fuyang, 236000, China.
| |
Collapse
|
30
|
Jang SH, Sohn SI, Park H, Lee SJ, Kim YW, Hong JM, Kim CH, Choi JW, Kang DH, Kim YS, Hwang YH, Lee JS, Hong JH. The Safety of Intra-arterial Tirofiban during Endovascular Therapy after Intravenous Thrombolysis. AJNR Am J Neuroradiol 2021; 42:1633-1637. [PMID: 34301637 DOI: 10.3174/ajnr.a7203] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/07/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The safety and efficacy of tirofiban during endovascular therapy in patients undergoing intravenous thrombolysis with recombinant IV tPA remain unclear. This study aimed to investigate the safety and efficacy of intra-arterial tirofiban use during endovascular therapy in patients treated with IV tPA. MATERIALS AND METHODS Using a multicenter registry, we enrolled patients with acute ischemic stroke who underwent endovascular therapy. Safety outcomes included postprocedural parenchymal hematoma type 2 and/or thick subarachnoid hemorrhage, intraventricular hemorrhage, and 3-month mortality. Efficacy outcomes included the successful reperfusion rate, postprocedural reocclusion, and good outcomes at 3 months (mRS scores of 0-2). The tirofiban effect on the outcomes was evaluated using a multivariable analysis while adjusting for potential confounders. RESULTS Among enrolled patients, we identified 314 patients with stroke (279 and 35 patients in the no tirofiban and tirofiban groups, respectively) due to an intracranial artery occlusion who underwent endovascular therapy with intravenous thrombolysis. A multivariable analysis revealed no association of intra-arterial tirofiban with postprocedural parenchymal hematoma type and/or thick subarachnoid hemorrhage (adjusted OR, 1.07; 95% CI, 0.20-4.10; P = .918), intraventricular hemorrhage (adjusted OR, 0.43; 95% CI, 0.02-2.85; P = .467), and 3-month mortality (adjusted OR, 0.38; 95% CI, 0.04-1.87; P = .299). Intra-arterial tirofiban was not associated with good outcome (adjusted OR, 2.22; 95% CI, 0.89 -6.12; P = .099). CONCLUSIONS Using intra-arterial tirofiban during endovascular therapy after IV tPA could be safe.
Collapse
Affiliation(s)
- S H Jang
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
| | - S-I Sohn
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
| | - H Park
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
| | - S-J Lee
- Department of Neurology (S.-J.L., J.M.H., J.S.L.)
| | - Y-W Kim
- Department of Neurology (Y.-W.K., Y.-H.H.)
| | - J M Hong
- Department of Neurology (S.-J.L., J.M.H., J.S.L.)
| | - C-H Kim
- Neurosurgery (C.-H.K.), School of Medicine Keimyung University, Daegu, South Korea
| | - J W Choi
- Radiology (J.W.C.), School of Medicine, Ajou University, Suwon, South Korea
| | | | - Y-S Kim
- Radiology (Y.-S.K.), School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Y-H Hwang
- Department of Neurology (Y.-W.K., Y.-H.H.)
| | - J S Lee
- Department of Neurology (S.-J.L., J.M.H., J.S.L.)
| | - J-H Hong
- From the Departments of Neurology (S.H.J., S.-I.S., H.P., J.-H.H.)
| |
Collapse
|
31
|
Liu J, Hu X, Wang Y, Guan X, Chen J, Liu H. The safety and effectiveness of early anti-platelet therapy after alteplase for acute ischemic stroke: A meta-analysis. J Clin Neurosci 2021; 91:176-182. [PMID: 34373024 DOI: 10.1016/j.jocn.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND For acute ischemic stroke patients, there is a risk of reocclusion after intravenous thrombolysis. In theory, early anti-platelet therapy can reduce the risk of vessel reocclusion. Although current guidelines do not recommend routine anti-platelet therapy within 24 h of intravenous thrombolytic therapy, many studies disagreed with it, especially after the emergence of new anti-platelet drugs. It is necessary to conduct a meta-analysis based on high-quality randomized controlled studies to re-evaluate this treatment strategy. METHODS Literature retrieval was systematically conducted in PubMed, Embase, Cochrane, Web of sicence, clinical trials, CNKI and Wanfang Data, for searching randomized controlled trials (published between January 1, 2000 and April 30, 2020 with no language restrictions) comparing early (within 24 h) with routine (after 24 h) anti-platelet-aggregation therapy after rt-PA intravenous thrombolysis. The primary safety endpoint and primary efficacy indicator are the incidence of symptomatic intracranial hemorrhage and a good prognosis at 90-day (modified Rankin Scale (mRS) score of 0-1 or return to baseline mRS), respectively. We assessed pooled data by use of a random-effects model. FINDINGS Of the 378 identified studies, only 3 were eligible and included in our analysis (N = 1008 participants). Compared with routine treatment, early anti-platelet-aggregation therapy after rt-PA intravenous thrombolysis in acute ischemic stroke patients did not affect the 90-day efficacy (95% CI 0.97 - 1.32). In terms of safety assessment, the early use of anti-platelet-aggregation drugs after thrombolysis has a neutral effect on the risk of intracranial hemorrhage, symptomatic intracranial hemorrhage, and bleeding from other systemic sites. CONCLUSION Early anti-platelet therapy after alteplase did not benefit the acute ischemic stroke patients based on the current evidence. However, more clinical trials and statistical evidence are still needed.
Collapse
Affiliation(s)
- Jiangyun Liu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, China; Jiangsu Province Academy of Traditional Chinese Medicine, China
| | - Xingxing Hu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, China; Jiangsu Province Academy of Traditional Chinese Medicine, China
| | - Yu Wang
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, China; Jiangsu Province Academy of Traditional Chinese Medicine, China
| | - Xueneng Guan
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, China; Jiangsu Province Academy of Traditional Chinese Medicine, China
| | - Jiao Chen
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, China; Jiangsu Province Academy of Traditional Chinese Medicine, China.
| | - Hongquan Liu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, China; Jiangsu Province Academy of Traditional Chinese Medicine, China.
| |
Collapse
|
32
|
Tao C, Zhu Y, Zhang C, Song J, Liu T, Yuan X, Luo W, Chen C, Liu D, Zhu Y, Liu J, Hu W. Association between tirofiban monotherapy and efficacy and safety in acute ischemic stroke. BMC Neurol 2021; 21:237. [PMID: 34167477 PMCID: PMC8223269 DOI: 10.1186/s12883-021-02268-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/04/2021] [Indexed: 01/11/2023] Open
Abstract
Background Studies 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). Methods In 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. Results In 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. Conclusions Our 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 registration Chinese clinical trial registry, ChiCTR2000034443, 05/07/2020. Retrospectively registered.
Collapse
Affiliation(s)
- Chunrong Tao
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Yuyou Zhu
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Chao Zhang
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Jianlong Song
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Tianlong Liu
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaodong Yuan
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Wenwu Luo
- Department of Pathology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Changchun Chen
- Department of Neurology, The Second People's Hospital of Anhui Province, Hefei, Anhui, China
| | - Dezhi Liu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of TCM, 528 Zhang-Heng Road,Pu-Dong New Area, Shanghai, 201203, China
| | - Yuanyuan Zhu
- People's Hospital of LiXin County, BoZhou City, 236700, AnHui Province, China
| | - Jie Liu
- People's Hospital of LiXin County, BoZhou City, 236700, AnHui Province, China.
| | - Wei Hu
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China.
| |
Collapse
|
33
|
Wang H, Hu H, Xu J, Qian C. Perfusion image guided mechanical thrombectomy combined with tirofiban successfully revascularize systemic lupus erythematosus related acute large vessel occlusion: A case report. Medicine (Baltimore) 2021; 100:e25779. [PMID: 33950971 PMCID: PMC8104300 DOI: 10.1097/md.0000000000025779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/15/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Systemic lupus erythematosus (SLE) is an important cause of stroke, more than a half the cases present as acute ischemic stroke. Thrombolysis is an effective choice in most cases, but for large vessel occlusion, mechanical thrombectomy is more effective. Here we reported a case of SLE-related stroke with left middle cerebral artery (MCA) occlusion, who was successfully treated by MT and tirofiban. PATIENT CONCERN A 38-year-old female suffered from right hemiplegia and aphasia for 8 hours. She was diagnosed with SLE 20 years ago, and neuropsychiatric SLE was considered 8 months before this onset. One month ago, glucocorticoids were discontinued by herself because of deterioration of bilateral femoral head osteonecrosis. DIAGNOSIS Left MCA occlusion was confirmed by computed tomography perfusion. INTERVENTION Immediate mechanical thrombectomy was performed and tirofiban was given to prevent re-occlusion of left MCA. Twenty fourhours later oral antiplatelet was given after intracranial hemorrhage was ruled out. OUTCOMES Her neurological symptom improved several days later, and she was transferred to further rehabilitation. At 4 months follow-up she can live independently with mild hypophrasia. There was no further events of ischemic stroke in 1-year follow-up. LESSONS Mechanical thrombectomy is a highly effective and indispensable treatment for SLE related large vessel occlusion. In addition, tirofiban may reduce vessel reocclusion in special cases such as SLE and artery stenosis.
Collapse
Affiliation(s)
- Han Wang
- Department of Geriatrics, Tongde Hospital of Zhejiang Province
| | | | - Jing Xu
- Department of Neurological Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Cong Qian
- Department of Neurological Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| |
Collapse
|
34
|
Movva H, Rabah R, Tekle W, Georgiadis A, Preston L, Kotta H, Hassan AE. There is no difference in safety and efficacy with Tirofiban or Eptifibatide for patients undergoing treatment of large vessel occlusion and underlying intracranial atherosclerosis. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2021. [DOI: 10.1016/j.inat.2020.100927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
35
|
Berge E, Whiteley W, Audebert H, De Marchis GM, Fonseca AC, Padiglioni C, de la Ossa NP, Strbian D, Tsivgoulis G, Turc G. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J 2021; 6:I-LXII. [PMID: 33817340 DOI: 10.1177/2396987321989865] [Citation(s) in RCA: 506] [Impact Index Per Article: 168.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/27/2020] [Indexed: 02/06/2023] Open
Abstract
Intravenous thrombolysis is the only approved systemic reperfusion treatment for patients with acute ischaemic stroke. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions with regard to intravenous thrombolysis for acute ischaemic stroke. These guidelines were developed based on the ESO standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote recommendations. Expert consensus statements were provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found high quality evidence to recommend intravenous thrombolysis with alteplase to improve functional outcome in patients with acute ischemic stroke within 4.5 h after symptom onset. We also found high quality evidence to recommend intravenous thrombolysis with alteplase in patients with acute ischaemic stroke on awakening from sleep, who were last seen well more than 4.5 h earlier, who have MRI DWI-FLAIR mismatch, and for whom mechanical thrombectomy is not planned. These guidelines provide further recommendations regarding patient subgroups, late time windows, imaging selection strategies, relative and absolute contraindications to alteplase, and tenecteplase. Intravenous thrombolysis remains a cornerstone of acute stroke management. Appropriate patient selection and timely treatment are crucial. Further randomized controlled clinical trials are needed to inform clinical decision-making with regard to tenecteplase and the use of intravenous thrombolysis before mechanical thrombectomy in patients with large vessel occlusion.
Collapse
Affiliation(s)
- Eivind Berge
- Department of Internal Medicine and Cardiology, Oslo University Hospital, Oslo, Norway
| | - William Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Heinrich Audebert
- Klinik und Hochschulambulanz für Neurologie, Charité Universitätsmedizin Berlin & Center for Stroke Research Berlin, Berlin, Germany
| | - Gian Marco De Marchis
- University Hospital of Basel & University of Basel, Department for Neurology & Stroke Center, Basel, Switzerland
| | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health (Neurology), Hospital Santa Maria-CHLN, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Chiara Padiglioni
- Neurology Unit-Stroke Unit, Gubbio/Gualdo Tadino and Città di Castello Hospitals, USL Umbria 1, Perugia, Italy
| | | | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Guillaume Turc
- Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Hopital Sainte-Anne, Université de Paris, Paris, France.,INSERM U1266.,FHU NeuroVasc
| |
Collapse
|
36
|
Zhao H, Feng Y, Rong X, Mao Y, Wang Z, Ling Y, Dong Q, Cao W. Sequential tirofiban infusions combined with endovascular treatment may improve outcomes in acute ischemic stroke - a meta-analysis. Aging (Albany NY) 2021; 13:5426-5441. [PMID: 33582658 PMCID: PMC7950282 DOI: 10.18632/aging.202473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/30/2020] [Indexed: 12/20/2022]
Abstract
In this meta-analysis, we explored whether tirofiban could safely improve outcomes when combined with endovascular therapy in acute ischemic stroke with large vessel occlusion. We searched the PubMed, EMBASE, Web of Science, and The Cochrane Library databases from January 2000 to October 2019 for relevant RCTs/non-RCTs. A total of 13 trials involving 2584 patients, of whom 893 (34.5%) received tirofiban, were ultimately included in the meta-analysis. The results suggested that tirofiban improved patient independence at 90 days (51.2% vs 42.4%; OR 1.26; p =0.02) without increasing the risk of symptomatic intracranial hemorrhage (OR 1.01; p =0.96) or mortality (OR 0.86; p =0.09). There was no association between the use of tirofiban and recanalization rate (OR 1.35; p =0.11). Subgroup analysis showed that a loading dose followed by maintenance doses, but not a single dose, of tirofiban increased favorable 90-day functional outcomes (OR 1.49; p =0.0008). Moreover, low maintenance doses may be more effective than high maintenance doses (OR 1.41; p =0.02). These results suggest that adjunctive tirofiban treatment administered as a loading dose followed by low-dose maintenance may improve functional outcomes of endovascular therapy in acute ischemic stroke.
Collapse
Affiliation(s)
- Hongchen Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiwei Feng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yiting Mao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zigao Wang
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yifeng Ling
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Wenjie Cao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
37
|
Huo X, Raynald, Wang A, Mo D, Gao F, Ma N, Wang Y, Wang Y, Miao Z. Safety and Efficacy of Tirofiban for Acute Ischemic Stroke Patients With Large Artery Atherosclerosis Stroke Etiology Undergoing Endovascular Therapy. Front Neurol 2021; 12:630301. [PMID: 33643207 PMCID: PMC7905208 DOI: 10.3389/fneur.2021.630301] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients with large artery atherosclerosis (LAA) stroke etiology receiving endovascular therapy (EVT). Methods: In this multi-center prospective study, patients who were considered to have an indication received a low dose intra-arterial bolus (0.25–1 mg) of tirofiban. The safety and efficacy outcomes at 90-day follow-ups included symptomatic intracranial hemorrhage (sICH), recanalization rate, functional outcome, and mortality. Results: Among the 649 AIS patients with LAA, those in the tirofiban group (n = 244) showed higher systolic blood pressure (BP) and NIHSS score on admission, puncture-to-recanalization time, lower frequency of intravenous thrombolysis and intra-arterial thrombolysis, higher frequency of antiplatelet, heparinization, mechanical stent retrieval, aspiration, balloon angioplasty, and more retrieval times compared with those in the non-tirofiban group (n = 405) (all P < 0.05). Tirofiban was found to be associated with superior clinical outcomes in anterior circulation stroke and major stroke patients [adjusted odds ratio (OR) = 2.163, 95% confidence interval (CI) = 1.130–4.140, P = 0.02 and adjusted OR = 2.361, 95% CI = 1.326–4.202, P = 0.004, respectively] and a lower risk of mortality at 90-day follow-ups (adjusted OR = 0.159, 95% CI = 0.042–0.599, P = 0.007 and adjusted OR = 0.252, 95% CI = 0.103–0.621, P = 0.003, respectively). There was no significant difference in sICH between the two groups. Conclusions: Tirofiban in AIS patients with LAA undergoing EVT is safe and may benefit the functional outcomes in anterior circulation and major stroke patients and showed a trend for reduced mortality.
Collapse
Affiliation(s)
- Xiaochuan Huo
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Raynald
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Dapeng Mo
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhongrong Miao
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
38
|
Tang L, Tang X, Yang Q. The Application of Tirofiban in the Endovascular Treatment of Acute Ischemic Stroke: A Meta-Analysis. Cerebrovasc Dis 2021; 50:121-131. [PMID: 33401276 DOI: 10.1159/000512601] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 10/21/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this meta-analysis is to evaluate the safety and efficacy of tirofiban during endovascular treatment (EVT) for acute ischemic stroke (AIS) patients. METHODS We systematically searched PubMed, Embase, Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) databases for randomized controlled trials and cohort studies (published before May 1, 2020; no language restrictions) comparing tirofiban administration to blank control during EVT in patients with AIS. Our primary end points were the 3-month functional outcome, recanalization rate, symptomatic intracerebral hemorrhage, and 3-month mortality. RESULTS The incidence of 3-month modified Rankin Scale (mRS) 0-2 score of the tirofiban group was higher than that of the control group (odds ratio [OR] = 1.27, 95% CI [1.09, 1.48], p = 0.002) with heterogeneity (I2 = 34%, p = 0.11). Data pooled from the 6 studies describing the details of retriever stent in EVT revealed that tirofiban was associated with higher incidence of 3-month mRS 0-2 score (OR = 1.48, 95% CI [1.11, 1.96], p = 0.007). The recanalization rate was higher in the tirofiban group compared to the control group (OR = 1.66, 95% CI [1.16, 2.39], p = 0.006). There were no statistically significant differences in the incidence of symptomatic intracranial hemorrhage (OR = 0.97, 95% CI [0.73, 1.31], p = 0.86) and intracranial hemorrhage (OR = 1.08, 95% CI [0.59, 1.97], p = 0.80) between tirofiban and non-tirofiban group. Besides, the tirofiban administration was associated with lower mortality (OR = 0.75, 95% CI [0.62, 0.91], p = 0.003). CONCLUSIONS The application of tirofiban in EVT of AIS may improve functional outcomes and reduce mortality at 3 months. Besides, tirofiban does not seem to increase the risk of symptomatic intracranial hemorrhage and intracranial hemorrhage, either in the anterior or posterior circulation stroke.
Collapse
Affiliation(s)
- Lisha Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China,
| | - Qianwen Yang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
39
|
Zhang H, Zheng L. Statistical analysis for efficacy of tirofiban combined with ozagrel in the treatment of progressive cerebral infarction patients out of thrombolytic therapy time window. Clinics (Sao Paulo) 2021; 76:e2728. [PMID: 34133479 PMCID: PMC8183337 DOI: 10.6061/clinics/2021/e2728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To investigate the safety and efficacy of combined tirofiban-ozagrel therapy for treating progressive stroke patients out of thrombolytic therapy time window. METHODS This prospective, double-blind, randomized controlled study included 337 patients who had experienced an acute ischemic stroke between November 2017 and December 2018. All patients were randomized into three groups: 1) the tirofiban/ozagrel group (n=113), 2) the tirofiban group (n=110), and 3) the ozagrel group (n=114). The platelet aggregation (PAG), thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB) levels in the patients from these groups were evaluated before starting treatment and then, at 24h, 7 days, and 14 days after treatment. The National Institutes of Health Stroke Scale (NIHSS) scores were evaluated before treatment and then, 24h, 1 week, 2 weeks, and 4 weeks after treatment. The Barthel Index (BI) score was used to measure safety, and the modified Rankin scale (mRS) was used to evaluate disability following 3 months of treatment. The risk factors affecting clinical outcomes were analyzed using logistic multivariate regression. RESULTS The mean NIHSS score for all the patients was 13.17±3.13 before treatment, and no significant difference between the basic clinical parameters of the three patient groups was found. Following treatment, both PAG and FIB were significantly reduced compared with the baseline (p<0.05). The levels of PAG and FIB in the tirofiban/ozagrel group were significantly lower than those in the tirofiban and ozagrel groups at 24h and 7 days after treatment (p<0.05). The NIHSS score decreased significantly in all treatment groups (p<0.05). The tirofiban/ozagrel NIHSS scores were significantly lower than that of the tirofiban and ozagrel groups at 24h, 1 week, and 2 weeks post initiation (p<0.05 for all). There were no significant differences in the BI and mRS scores or the intracranial hemorrhage rates; further, age, sex, Trial of ORG 10172 in acute stroke treatment (TOAST) type, baseline NIHSS and 24-h NIHSS scores, baseline thrombus-related factors, and treatment methods were shown to not be independent risk factors for clinical outcomes. CONCLUSION The combination of tirofiban and ozagrel, as well as monotherapy with either tirofiban or ozagrel, transiently improves the neural function of patients and reduces platelet aggregation and fibrinogen formation in the first 4 weeks following a stroke event; additionally, none of these treatments increased the risk for hemorrhage in these progressive stroke patients over a 3-month period.
Collapse
Affiliation(s)
- Huiying Zhang
- School of Statistics, ShanXi University of Finance & Economics, Taiyuan, Shanxi Province, 030006, China
| | - Lei Zheng
- Department of Cardiovascular Medicine, ShanXi Bethune Hospital, Taiyuan, Shanxi Province, 030032, China
- Corresponding author. E-mail:
| |
Collapse
|
40
|
Liu C, Xie J, Sun S, Li H, Li T, Jiang C, Chen X, Wang J, Le A, Wang J, Li Z, Wang J, Wang W. Hemorrhagic Transformation After Tissue Plasminogen Activator Treatment in Acute Ischemic Stroke. Cell Mol Neurobiol 2020; 42:621-646. [PMID: 33125600 DOI: 10.1007/s10571-020-00985-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/22/2020] [Indexed: 12/17/2022]
Abstract
Hemorrhagic transformation (HT) is a common complication after thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) in ischemic stroke. In this article, recent research progress of HT in vivo and in vitro studies was reviewed. We have discussed new potential mechanisms and possible experimental models of HT development, as well as possible biomarkers and treatment methods. Meanwhile, we compared and analyzed rodent models, large animal models and in vitro BBB models of HT, and the limitations of these models were discussed. The molecular mechanism of HT was investigated in terms of BBB disruption, rt-PA neurotoxicity and the effect of neuroinflammation, matrix metalloproteinases, reactive oxygen species. The clinical features to predict HT were represented including blood biomarkers and clinical factors. Recent progress in neuroprotective strategies to improve HT after stroke treated with rt-PA is outlined. Further efforts need to be made to reduce the risk of HT after rt-PA therapy and improve the clinical prognosis of patients with ischemic stroke.
Collapse
Affiliation(s)
- Chengli Liu
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jie Xie
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Shanshan Sun
- Department of Ultrasound Imaging, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Hui Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Tianyu Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Chao Jiang
- Department of Neurology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Xuemei Chen
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Henan, 450000, People's Republic of China
| | - Junmin Wang
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Henan, 450000, People's Republic of China
| | - Anh Le
- Washington University in St. Louis, Saint Louis, MO, 63130, USA
| | - Jiarui Wang
- The Johns Hopkins University, Baltimore, MD, 21218, USA
| | - Zhanfei Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Jian Wang
- Department of Anatomy, College of Basic Medical Sciences, Zhengzhou University, Henan, 450000, People's Republic of China.
| | - Wei Wang
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China.
| |
Collapse
|
41
|
Lin S, He X, Zhai G, Wang C, Xue H, Lin S. Prospective study of the effect of sulfotanshinone sodium combined with tirofiban on vascular endothelial function and indicators of plaque stability in elderly patients with acute coronary syndrome. J Clin Pharm Ther 2020; 46:319-327. [PMID: 33104258 DOI: 10.1111/jcpt.13283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 01/06/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE This study aimed to explore the effect of sulfotanshinone sodium injection combined with tirofiban on vascular endothelial function and indicators of plaque stability in elderly patients with acute coronary syndrome (ACS). METHODS We designed a prospective study and enrolled 169 patients with ACS who were admitted to our hospital as subjects. Patients treated with sulfotanshinone sodium injection combined with tirofiban (n = 99) were allocated to the research group (RG), and the remaining patients treated with tirofiban alone were allocated to the control group (n = 70; CG). The two groups were compared in terms of treatment efficacy, adverse reactions, vascular endothelial function, changes in plaque stability indicator levels, prognosis, recurrence rate, and quality of life after the treatment. RESULTS AND DISCUSSION Treatment response rate, SOD and ET-1 levels, and quality-of-life score were markedly lower in RG than in CG (all P < .05). The incidence of adverse reactions; levels of CD63p, CD62p and GP IIb/IIIa; changes in plaque stability indicator levels; and recurrence rate were markedly higher in RG than in CG (all P < .05). There was no significant difference in 3-year survival rate between the two groups (P > .05). WHAT IS NEW AND CONCLUSION Compared with tirofiban alone, sulfotanshinone sodium injection combined with tirofiban had superior efficacy and safety in the treatment of ACS. It can effectively reduce recurrence rate and improve quality of life in ACS, making it a strong candidate for popular clinical application.
Collapse
Affiliation(s)
- Shuqing Lin
- Department of Emergency, Binzhou Center Hospital, Binzhou, China
| | - Xinze He
- Department of Emergency, Binzhou Center Hospital, Binzhou, China
| | - Guiliang Zhai
- Department of Emergency, Binzhou Center Hospital, Binzhou, China
| | - Chenggang Wang
- Department of Emergency, Binzhou Center Hospital, Binzhou, China
| | - Huiping Xue
- Department of Emergency, Binzhou Center Hospital, Binzhou, China
| | - Shufeng Lin
- Department of Emergency, Binzhou Center Hospital, Binzhou, China
| |
Collapse
|
42
|
Tong X, Cao Y, Wang W, Wang D, Wang Y, Wang Y. Benefit and risk of early intravenous heparin after thrombolysis in patients with acute ischemic stroke. Brain Behav 2020; 10:e01776. [PMID: 32892463 PMCID: PMC7559612 DOI: 10.1002/brb3.1776] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND PURPOSE We performed a retrospective analysis of the "Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)" registry to explore the benefit and risk of intravenous thrombolysis (IVT) followed by intravenous heparin (IVH) in acute ischemic stroke (AIS) patients. METHODS In the TIMS-China database, the patients who received IVH immediately after IVT (Early IVH group) and those who initiated antithrombotic therapy (ATT) until 24 hr after IVT (Standard ATT group) were screened for this comparison. Propensity score (PS) matching was performed between both groups. The logistic regression analysis was performed in the matched population to compare all the efficacy and safety outcomes. RESULTS Of 1,437 patients in this study, 119 received early IVH and 1,318 cases initiated standard ATT. After PS matching (1:2), 117 pairs were identified. The early IVH group had higher proportions of neurological improvement at 24 hr (OR = 2.24, 95% CI = 1.42-3.53) and 7 days (OR = 1.92, 95% CI = 1.22-3.03), better chance of excellent recovery (OR = 1.69, 95% CI = 1.07-2.67) and functional independence (OR = 1.77, 95% CI = 1.13-2.78) at 90 days, and a lower 90-day mortality (OR = 0.44, 95% CI = 0.21-0.92) than standard ATT group. Additionally, early IVH did not increase the risk of symptomatic intracranial hemorrhage (OR = 0.92, 95% CI = 0.34-2.48). CONCLUSIONS IVH immediately after thrombolysis seems to be safe and potentially more effective as compared with standard ATT delay of 24 hr for a subset of AIS patients.
Collapse
Affiliation(s)
- Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yibin Cao
- Department of Neurology, Tangshan Gongren Hospital, Hebei Medical University, Tangshan, China
| | - Wenzhi Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - David Wang
- Illinois Neurological Institute Stroke Network, Sisters of the Third Order of St Francis Healthcare System, University of Illinois College of Medicine, Peoria, IL, USA
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | |
Collapse
|
43
|
Yang J, Wu Y, Gao X, Bivard A, Levi CR, Parsons MW, Lin L. Intraarterial Versus Intravenous Tirofiban as an Adjunct to Endovascular Thrombectomy for Acute Ischemic Stroke. Stroke 2020; 51:2925-2933. [PMID: 32933416 DOI: 10.1161/strokeaha.120.029994] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE This study aimed to evaluate the treatment effect of intraarterial versus intravenous tirofiban during endovascular thrombectomy in acute ischemic stroke. METHODS This study retrospectively examined 503 patients with acute ischemic stroke with large vessel occlusion who received endovascular thrombectomy within 24 hours of stroke onset. Patients were divided into 3 groups: no tirofiban (n=354), intraarterial tirofiban (n=79), and intravenous tirofiban (n=70). The 3 groups were compared in terms of recanalization rate, symptomatic intracerebral hemorrhage, in-hospital death rate, 3-month death, and 3-month outcomes measured by modified Rankin Scale score (good clinical outcome of 0-2, poor outcome of 5-6). The comparison was statistically assessed by propensity score matching, followed by Freidman rank-sum test and pairwise Wilcoxon signed-rank test with Bonferroni correction. RESULTS The propensity score matching resulted in 92 matched triplets. Compared with the no-tirofiban group, the intravenous tirofiban group showed significantly increased recanalization (96.7% versus 64.1%, P<0.001), an increased rate of 3-month good outcome (69.5% versus 51.2%, P=0.034), and a lower rate of 3-month poor outcome (12.2% versus 41.4%, P<0.001). There was no significant difference between the tirofiban intravenous and no-tirofiban groups in terms of symptomatic intracerebral hemorrhage (2.2% versus 0%, P=1.000). However, symptomatic intracerebral hemorrhage was significantly increased in the intraarterial-tirofiban group compared with the no-tirofiban group (19.1% versus 0%, P<0.001), with an increased rate of in-hospital death (23.6% versus 0% P<0.001), and increased rate of 3-month death (26.8% versus 11.1%, P=0.021). The intraarterial-tirofiban and no-tirofiban group showed no significant difference in recanalization rate (66.3% versus 64.1%, P=1.000). CONCLUSIONS As an adjunct to endovascular thrombectomy, intravenous tirofiban is associated with high recanalization rate and good outcome, whereas intraarterial tirofiban is associated with high hemorrhagic rate and death rate.
Collapse
Affiliation(s)
- Jianhong Yang
- Department of Neurology (J.Y., Y.W.), Ningbo First Hospital, Zhejiang, China
| | - Yuefei Wu
- Department of Neurology (J.Y., Y.W.), Ningbo First Hospital, Zhejiang, China
| | - Xiang Gao
- Department of Neurosurgery (X.G.), Ningbo First Hospital, Zhejiang, China
| | - Andrew Bivard
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Australia (A.B., M.W.P.)
| | - Christopher R Levi
- School of Medicine and Public Health, University of Newcastle, Australia (C.R.L., M.W.P., L.L.)
| | - Mark W Parsons
- Melbourne Brain Centre at Royal Melbourne Hospital, University of Melbourne, Australia (A.B., M.W.P.).,School of Medicine and Public Health, University of Newcastle, Australia (C.R.L., M.W.P., L.L.)
| | - Longting Lin
- School of Medicine and Public Health, University of Newcastle, Australia (C.R.L., M.W.P., L.L.)
| | | |
Collapse
|
44
|
Wang H, Li X, Liu C, Huang S, Liang C, Zhang M. Effects of Oral Antiplatelet Agents and Tirofiban on Functional Outcomes of Patients with Non-Disabling Minor Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:104829. [PMID: 32689578 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/20/2020] [Accepted: 03/22/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND PURPOSE Over half of patients with acute ischemic stroke present with minor neurologic deficits. We investigated the effects of oral antiplatelet agents vs. tirofiban, a highly selective GP IIb/IIIa antiplatelet drug, on functional outcomes of stroke patients with non-disabling neurologic deficits. METHODS This retrospective study analyzed data of 125 patients with minor stroke who had National Institutes of Health Stroke Scale (NIHSS) scores of 5 or less within 6 hours of stroke symptom onset between January 2010 and June 2018. All patients were selected from the Department of Neurology at the Third Affiliated Hospital of Army Medical University. There were 54 cases in each group after propensity score matching, in which patients received oral antiplatelet agents (n = 64) and tirofiban (n = 61). Safety outcomes were assessed by incident intracranial hemorrhage, systemic bleeding and death. Efficacy outcomes were assessed using the NIHSS score at 24 hrs, 7 days or at discharge, and clinical deterioration. The modified rankin scale (mRs) was assessed at 90 days. RESULTS No significant differences were found in the incidence of intracranial hemorrhage, systemic bleeding or death between groups (P>0.05). Although neurological function improved significantly in both groups, NIHSS scores were lower in the tirofiban group compared with those in the oral antiplatelet agents group at 24 hrs (1 versus 3, P = 0.000), 7 days or at discharge (0 versus 2, P = 0.000). The clinical deterioration rate was higher in the oral antiplatelet agents group than in the tirofiban group, but without significance (16.7% versus 5.6%, P = 0.126). Functional outcomes (mRs = 0) were more favorable in the tirofiban group than in the oral antiplatelet agents group (66.7% vs. 44.4%; adjusted odds ratio 3.32; 95% CI: 1.38-7.99; P = 0. 008). CONCLUSION Intravenous tirofiban seems to be safe and effective with more favorable functional outcomes than oral antiplatelet agents, suggesting that tirofiban is a viable treatment choice for selected patients with non-disabling minor acute ischemic stroke.
Collapse
Affiliation(s)
- Huan Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoshu Li
- Department of Neurology, The Third Affiliated Hospital of Army Medical University, Chongqing, China
| | - Chengchun Liu
- Department of Neurology, The Third Affiliated Hospital of Army Medical University, Chongqing, China
| | - Shuhan Huang
- Department of Neurology, The Third Affiliated Hospital of Army Medical University, Chongqing, China
| | - Chunrong Liang
- Department of Neurology, The Third Affiliated Hospital of Army Medical University, Chongqing, China
| | - Meng Zhang
- Department of Neurology, The Third Affiliated Hospital of Army Medical University, Chongqing, China.
| |
Collapse
|
45
|
Zhu X, Cao G. Safety of Glycoprotein IIb-IIIa Inhibitors Used in Stroke-Related Treatment: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2020; 26:1076029620942594. [PMID: 32727211 PMCID: PMC7394033 DOI: 10.1177/1076029620942594] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Endovascular therapy and intravenous thrombolysis with recombinant tissue plasminogen activator are the 2 most recommended treatments for acute ischemic stroke (AIS). Glycoprotein (GP) IIb-IIIa inhibitors are short-acting selective reversible antiplatelet agents that emerged as promising therapeutic agents for AIS about 10 years ago. Given the unclear safety profile and application coverage of GP inhibitors, we conducted this meta-analysis to explore the same. Methods: We used GP IIb-IIIa inhibitors, intracranial hemorrhage, and mortality as the key words on Medline, Web of Science, and the Embase databases. Randomized controlled trials, prospective literatures, and retrospective studies in English published between 1990 and 2020 were screened. The outcomes were relative risk (RR) of death and 90-day intracerebral hemorrhage (ICH). We pooled the results in 2 categories and conducted a subgroup analysis stratified by different drugs. The choice of the effects model depended on the value of I2. Results: In all, 3700 patients from 20 studies were included. No GP IIb-IIIa inhibitors were found to have a remarkable influence on the ICH rate. The RR values of symptomatic ICH for abciximab and eptifibatide were 4.26 (1.89, 9.59) and 0.17 (0.04, 0.69), respectively. Both tirofiban and abciximab could decrease the mortality rate within 90 days. Age > 70 years, National Institutes of Health Stroke Scale > 15, and overall dose > 10 mg are risk factors for ICH events with tirofiban usage. Thrombectomy combined with tirofiban was safe for arterial reocclusion prevention. Conclusions: In stroke-related treatment, administration of GP IIb-IIIa inhibitors could be safe, but care should be taken regarding drug species and doses. Abciximab can increase the risk of symptomatic intracranial hemorrhage. Tirofiban and eptifibatide can be considered safe in low doses. Suitable patients should be selected using strict criteria.
Collapse
Affiliation(s)
- Xiaolin Zhu
- Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.,Both the authors contributed equally to this work
| | - Genmao Cao
- Department of Vascular Surgery, Second Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.,Both the authors contributed equally to this work
| |
Collapse
|
46
|
Shi J, Shi R, Qin W, Zhang X, Liu H, Xu J, Liu CF, Cao Y. Dynamic Changes in Fibrinogen and Prognosis of Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis. Neurotox Res 2020; 38:775-784. [DOI: 10.1007/s12640-020-00241-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/29/2023]
|
47
|
Liu B, Zhang H, Wang R, Qu H, Sun Y, Zhang W, Zhang S. Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease. J Int Med Res 2020; 48:300060520926298. [PMID: 32459110 PMCID: PMC7273788 DOI: 10.1177/0300060520926298] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To investigate the effects of early administration of tirofiban after
intravenous thrombolysis on early neurological deterioration in patients
with branch atheromatous disease. Methods We analyzed clinical data from patients with branch atheromatous disease. We
enrolled seven cases into the urokinase-only (UO) control group and 10 cases
into the urokinase + tirofiban (UT) treatment group. National Institutes of
Health Stroke Scale (NIHSS) scores were obtained at admission and on days 3
and 5 after admission. Modified Rankin Scale (mRS) scores were obtained 3
months after admission. Results Significant differences between the UO and UT groups were evident on days 3
and 5 after admission. In the UT group, there was a significant difference
between NIHSS scores at admission and on day 5, while there were no
significant differences in scores in the UO group. The early neurological
deterioration rates were not significantly different between the two groups.
However, there were significant differences in these rates at 72 and 120
hours. Both the mRS scores and the prognoses at 3 months differed between
the two groups. Conclusion Early administration of tirofiban after urokinase-mediated intravenous
thrombolysis reduces early neurological deterioration and improves the
long-term prognosis of patients with branch atheromatous disease.
Collapse
Affiliation(s)
- Bin Liu
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| | - Hong Zhang
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| | - Rong Wang
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| | - Hongdang Qu
- Department of Neurology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui Province, China
| | - Yifei Sun
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| | - Wanlong Zhang
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| | - Shuye Zhang
- Department of Neurology, Suzhou First People's Hospital, Suzhou, Anhui Province, China
| |
Collapse
|
48
|
The Safety and Efficiency of Tirofiban in Acute Ischemic Stroke Patients Treated with Mechanical Thrombectomy: A Multicenter Retrospective Cohort Study. Biochem Res Int 2020; 2020:5656173. [PMID: 32399299 PMCID: PMC7211241 DOI: 10.1155/2020/5656173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/25/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023] Open
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.
Collapse
|
49
|
The "distal-to-proximal" strategy for the treatment of posterior circulation tandem occlusions: a single-centre experience. Neuroradiology 2020; 62:867-876. [PMID: 32242265 DOI: 10.1007/s00234-020-02412-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Data on posterior circulation tandem occlusions in acute ischemic stroke are scarce: recognition may be challenging and little is known about optimal treatment strategy. We report our endovascular treatment strategy for posterior circulation tandem occlusion. METHODS Consecutive patients with posterior circulation tandem occlusions in our centre were enrolled retrospectively. The preferred strategy was "distal-to-proximal" strategy, which means opening the distal occlusion first followed by treatment of the proximal pathology. The imaging characteristics, treatment strategy, clinical outcomes, and complications of patients with posterior circulation tandem occlusions were analyzed. RESULTS In total, 21 patients with posterior circulation tandem occlusions were enrolled in the study, which accounted for 23.6% of patients with posterior circulation stroke in our centre. The mean age was 60 years (range 32 to 80), and median pre-procedure NIHSS score was 28 (interquartile range: 13-31). Eighteen patients (85.7%) had vertebrobasilar artery tandem occlusions and 3 (14.3%) had basilar artery to basilar artery tandem occlusions. All distal occlusions were successfully recanalized (modified TICI 2b/3). Two (9.5%) of the proximal lesions were not treated. A total of 57.1% of the patients had stents implanted on the proximal occlusions. The rate of mRS 0-3 at 3 months was 57.1% and the mortality rate was 19.0%. CONCLUSION In patients with acute ischaemic stroke caused by posterior circulation tandem occlusions, we favor "distal-to-proximal" strategy based on the positive results in this small series. Nevertheless, a more extensive study is required to explore the optimal treatment strategy further.
Collapse
|
50
|
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. [DOI: 10.1016/j.jstrokecerebrovasdis.2019.104619] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 12/15/2019] [Accepted: 12/19/2019] [Indexed: 11/21/2022] Open
|