Journal Home > Volume 10 , Issue 4
Objective

To investigate the effectiveness and safety of tirofiban in patients with acute ischemic stroke (AIS) without large-vessel occlusions and not receiving intravenous thrombolysis.

Methods

Overall, 267 cases were included in the study (134 cases in tirofiban group; 133 cases in control group). After admission, patients in the tirofiban group were administered tirofiban for at least 72 h, and aspirin 100 mg and hydroclopidogrel 75 mg were administered 4 h before discontinuation of tirofiban administration. All patients were followed for 3 months, and the National Institutes of Health Stroke Scale (NIHSS) scores on admission, 24 h, and 7 d after treatment, intracerebral hemorrhage transformation within 48 h from stroke onset, and bleeding were assessed.

Results

There was no significant difference between both groups in the incidence of non-symptomatic and symptomatic intracranial hemorrhage (sICH), extracranial hemorrhage events, and thrombocytopenia (p > 0.05). There was a significant different between the NIHSS scores at baseline and 7 d after treatment in the tirofiban group (p = 0.043). At 90 d after treatment, the proportion of patients with a good prognosis in the tirofiban group (modified Rankin Scale [mRS] = 0, 1) was higher than that in the control group (p = 0.021). There was no difference in the proportion of patients with a mRS score of 0–2 between the two groups (p > 0.05).

Conclusion

Administration of tirofiban for > 72 h (72 h–108 h) is safe and can improve the long-term (90 d) prognosis of patients with AIS without large-vessel occlusions and not receiving intravenous thrombolysis.


menu
Abstract
Full text
Outline
About this article

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

Show Author's information Yongpeng Yua( )Yali ZhengbXia DongcXiaohong QiaodYu Taod
Center of Neurology, Qingdao Traditional Chinese Medicine Hospital (Qingdao Hiser Hospital), Qingdao University, Qingdao 266033, Shangdong, China
Department of Neurology, Tai'an Central Hospital Affiliated to Qingdao University, Qingdao 271099, Shandong, China
Graduate School of Weifang Medical College, Weifang 261053, Shandong, China
Department of Neurology, The Eighth Clinical College of Qingdao University, Weihai 264400, Shandong, China

Abstract

Objective

To investigate the effectiveness and safety of tirofiban in patients with acute ischemic stroke (AIS) without large-vessel occlusions and not receiving intravenous thrombolysis.

Methods

Overall, 267 cases were included in the study (134 cases in tirofiban group; 133 cases in control group). After admission, patients in the tirofiban group were administered tirofiban for at least 72 h, and aspirin 100 mg and hydroclopidogrel 75 mg were administered 4 h before discontinuation of tirofiban administration. All patients were followed for 3 months, and the National Institutes of Health Stroke Scale (NIHSS) scores on admission, 24 h, and 7 d after treatment, intracerebral hemorrhage transformation within 48 h from stroke onset, and bleeding were assessed.

Results

There was no significant difference between both groups in the incidence of non-symptomatic and symptomatic intracranial hemorrhage (sICH), extracranial hemorrhage events, and thrombocytopenia (p > 0.05). There was a significant different between the NIHSS scores at baseline and 7 d after treatment in the tirofiban group (p = 0.043). At 90 d after treatment, the proportion of patients with a good prognosis in the tirofiban group (modified Rankin Scale [mRS] = 0, 1) was higher than that in the control group (p = 0.021). There was no difference in the proportion of patients with a mRS score of 0–2 between the two groups (p > 0.05).

Conclusion

Administration of tirofiban for > 72 h (72 h–108 h) is safe and can improve the long-term (90 d) prognosis of patients with AIS without large-vessel occlusions and not receiving intravenous thrombolysis.

Keywords: Safety, Thrombolysis, Effectiveness, Cerebral infarction, Tirofiban

References(30)

1

Yu YP, Tan L. The vulnerability of vessels involved in the role of embolism and hypoperfusion in the mechanisms of ischemic cerebrovascular diseases. BioMed Res Int. 2016;2016: 8531958.

2

Wang J, Zhao JH, Li SM. Research progress on the therapeutic effect of olfactory ensheathing cell transplantation on ischemic stroke. J Neurorestoratol. 2021;9(2): 83-93.

3

Feng J, Zhu ZH, Waqas A, et al. Endovascular thrombectomy for the treatment of ischemic stroke: an updated meta-analysis for a randomized controlled trial. J Neurorestoratol. 2021;9(3): 166-176.

4

Guo XL, Xue Q, Zhao JH, et al. Clinical diagnostic and therapeutic guidelines of stroke neurorestoration (2020 China version). J Neurorestoratol. 2020;8(4): 241-251.

5

Qiu T, Li CQ, Huang LM, et al. Tirofiban combined with heparin's effect and safety in the treatment of mild to moderate acute ischemic stroke. Neurol Res. 2021;43(3): 220-224.

6

King S, Short M, Harmon C. Glycoprotein IIb/IIIa inhibitors: the resurgence of tirofiban. Vasc Pharmacol. 2016;78: 10-16.

7

Kraft P, Schuhmann MK, Fluri F, et al. Efficacy and safety of platelet glycoprotein receptor blockade in aged and comorbid mice with acute experimental stroke. Stroke. 2015;46(12): 3502-3506.

8

Novello S, Le Chevalier T. Chemotherapy for non-small-cell lung cancer. Part 1: early-stage disease. Oncology. 2003;17(3): 357-364.

9

Ihn YK, Sung JH, Kim BS. Intravenous glycoprotein IIb/IIIa inhibitor (tirofiban) followed by low-dose intra-arterial urokinase and mechanical thrombolysis for the treatment of acute stroke. NeuroRadiol J. 2011;24(6): 907-913.

10

Wu CJ, Sun CH, Wang LJ, et al. Low-dose tirofiban treatment improves neurological deterioration outcome after intravenous thrombolysis. Stroke. 2019;50(12): 3481-3487.

11

Zhang HQ, Lin F, Zhao YJ, et al. Assessing the efficacy and safety of tirofiban in combination with dual-antiplatelet therapy in progressive ischemic stroke patients. J Cardiovasc Pharmacol. 2021;78(3): 448-452.

12

Du N, Wang LX, Liu YL, et al. Effect of tirofiban in treating patients with progressive ischemic stroke. Eur Rev Med Pharmacol Sci. 2022;26(6): 2098-2105.

13

Han B, Ma T, Liu ZD, et al. Efficacy and safety of tirofiban in clinical patients with acute ischemic stroke. Front Neurol. 2021;12: 785836.

14

Tao CR, Zhu YY, Zhang C, et al. Association between tirofiban monotherapy and efficacy and safety in acute ischemic stroke. BMC Neurol. 2021;21(1): 237.

15

Gong JH, Shang JJ, Yu H, et al. Tirofiban for acute ischemic stroke: systematic review and meta-analysis. Eur J Clin Pharmacol. 2020;76(4): 475-481.

16

Niu JL, Ding YL, Zhai TT, et al. The efficacy and safety of tirofiban for patients with acute ischemic stroke: a protocol for systematic review and a metaanalysis. Medicine (Baltim). 2019;98(9), e14673.

17

Zhang AW, Wu NH, Liu XT, et al. Continuous intravenous tirofiban can improve the 90-day functional outcome and decrease 90-day mortality without increasing bleeding risk in acute ischemic stroke patients treated by endovascular therapy: a meta-analysis. J Clin Neurosci. 2022;99: 109-116.

18

Lin L, Li W, Liu CC, et al. Safety and preliminary efficacy of intravenous tirofiban in acute ischemic stroke patient without arterial occlusion on neurovascular imaging studies. J Neurol Sci. 2017;383: 175-179.

19

Adams Jr HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993;24(1): 35-41.

20

Yang D, Lin M, Wang SP, et al. Primary angioplasty and stenting may be superior to thrombectomy for acute atherosclerotic large-artery occlusion. Intervent Neuroradiol. 2018;24(4): 412-420.

21

Knottnerus IL, Govers-Riemslag JW, Hamulyak K, et al. Endothelial activation in lacunar stroke subtypes. Stroke. 2010;41(8): 1617-1622.

22

Giordano A, D'Angelillo A, Romano S, et al. Tirofiban induces VEGF production and stimulates migration and proliferation of endothelial cells. Vasc Pharmacol. 2014;61(2/3): 63-71.

23

Liu CP, Lin MS, Chiu YW, et al. Additive benefit of glycoprotein IIb/IIIa inhibition and adjunctive Thrombus aspiration during primary coronary intervention: results of the Initial Thrombosuction and Tirofiban Infusion (ITTI) trial. Int J Cardiol. 2012;156(2): 174-179.

24

Yang M, Huo XC, Miao ZR, et al. Platelet glycoprotein IIb/IIIa receptor inhibitor tirofiban in acute ischemic stroke. Drugs. 2019;79(5): 515-529.

25

Siebler M, Hennerici MG, Schneider D, et al. Safety of tirofiban in acute ischemic stroke: the SaTIS trial. Stroke. 2011;42(9): 2388-2392.

26

Zhang HQ, Chang WS, Lin F, et al. Clinical efficacy and safety of tirofiban combined with dual antiplatelet therapy in patients with progressive stroke (in Chinese). Chin J Postgraduates Med. 2020;43(5): 388-392.

27

Philipps J, Thomalla G, Glahn J, et al. Treatment of progressive stroke with tirofiband—xperience in 35 patients. Cerebrovasc Dis. 2009;28(5): 435-438.

28

Wang H, Li XS, Liu CC, et al. 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(8): 104829.

29

Junghans U, Seitz RJ, Aulich A, et al. Bleeding risk of tirofiban, a nonpeptide GPIIb/IIIa platelet receptor antagonist in progressive stroke: an open pilot study. Cerebrovasc Dis. 2001;12(4): 308-312.

30

Torgano G, Zecca B, Monzani V, et al. Effect of intravenous tirofiban and aspirin in reducing short-term and long-term neurologic deficit in patients with ischemic stroke: a double-blind randomized trial. Cerebrovasc Dis. 2010;29(3): 275-281.

Publication history
Copyright
Rights and permissions

Publication history

Received: 10 March 2022
Revised: 25 June 2022
Accepted: 10 August 2022
Published: 29 September 2022
Issue date: December 2022

Copyright

© 2022 The Authors. Published by Elsevier Ltd on behalf of Tsinghua University Press.

Rights and permissions

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Return