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

Purpose Early neurological deterioration (END) is common after acute ischemic stroke (AIS) and associated with poor outcome. The antithrombotic strategy for END is still a pending question without specific evidence-based recommendation. Whether traditional oral antiplatelet (AP) drug or intravenous tirofiban is more beneficial for END needs further research. Our study aimed to compare the efficacy and safety of tirofiban with oral AP drugs in patients who experienced END without thrombolysis or mechanical thrombectomy and evaluate which stratified population gained the most benefit from tirofiban. Methods A total of 222 AIS patients with END from January 2016 to June 2021 were retrospectively enrolled and divided into the oral AP group and tirofiban group. The functional outcome was assessed with the National Institute of Health Stroke Scale (NIHSS) at discharge and modified Rankin scale (mRS) at 90 days. Results Compared with the oral AP group, more patients in the tirofiban group achieved NIHSS improvement by ≥2 points at discharge (61.7% vs. 25.2%, p = 0.000) and a favorable outcome (mRS 0-2) at 90 days (60.7% vs. 42.6%, p = 0.007). No moderate or severe hemorrhage occurred, and mild hemorrhage was comparable in both groups (p = 0.199). Logistic regression demonstrated that tirofiban was associated with NIHSS improvement at discharge [adjusted odds ratio (OR) 4.930; 95% confidence interval (CI) 2.731-8.898] and 90-day favorable outcome (adjusted OR 2.242; 95% CI 1.080-4.653). Subgroup analysis showed that compared with oral AP, tirofiban improved NIHSS scores at discharge in all subgroups, and improved 90-day mRS in the subgroups of large-artery atherosclerosis (p = 0.004), age ≤75 years (p = 0.03), and NIHSS 4-7 (p = 0.001). Conclusions Based on our results, tirofiban monotherapy could be an alternative to traditional oral AP strategy for the treatment of END.

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 to 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 tirofiban group and 35 in control group.The reduction of the NIHSS score in 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). Sixteen patients (16.7%) in tirofiban group and 14 patients (40%) in control group died during hospitalization (P=0.029, OR, 3.333; 95% CI, 1.102-10.088). There was significant difference in mRS 5-6 scores at 90 days between the two groups (P=0.023, OR, 3.055; 95% CI, 1.154-8.088). Howere,there was no difference in mRS 0-1 (P=0.321, OR, 0.5; 95% CI, 0.396-0.632),mRS 2 (P=0.572, OR, 0.579; 95% CI, 0.043-5.777) or mRS 3 (P=0.225, OR, 0.452; 95% CI, 0.123-1.665) scores between the two groups. There was no difference in symptomatic intracranial hemorrhage (P=0.29, OR, 3.281; 95% CI, 0.325-33.169) ,asymptomatic intracranial hemorrhage (P=0.123, OR, 3.517; 95% CI, 0.659-18.782) or systemic bleeding events during hospitalization (P=0.044, OR, 3.235; 95% CI, 1.00-10.469).Conclusions: Low-dose and long-course tirofiban treatment can significantly improve the early neurological function and reduce the in-hospital mortality in LHI patients. It also can improve the quality of life and ability of daily living at 90 days.Meanwhile, tirofiban do not increase the risk of any type of bleeding events.

Background: Intravenous thrombolysis is the preferred clinical treatment for ultra-early (<4.5 h) ischemic stroke. However, whether intravenous thrombolysis should be used in patients with mild stroke remains controversial. This study reports a systematic review and meta-analysis of the efficacy and safety of intravenous thrombolysis in acute mild stroke. Methods: The PubMed, Cochrane Library, MEDLINE, Embase and CBM disc databases were searched for studies on intravenous thrombolysis versus nonthrombolysis in acute mild stroke. All studies published in English prior to March 2022 were retrieved. The studies were screened and selected based on the inclusion and exclusion criteria. Then, the data were extracted and recorded by trained researchers. RevMan 5.4 statistical software was used to analyze the data on the efficacy (mRS score, stroke recurrence rate and mortality at 90 days) and safety (intracranial hemorrhage, symptomatic intracranial hemorrhage) of the patients with acute mild stroke in the intravenous thrombolysis and nonthrombolysis groups. Results: A total of 14 high-quality studies containing 86,063 patients with acute mild stroke (8,824 in the intravenous thrombolysis group; 77,239 in the nonthrombolysis group) were included in this meta-analysis. The meta-analysis results were as follows: (1) Efficacy: There were significant differences in mRS scores of 0~1 and 0~2 between the intravenous thrombolysis and nonthrombolysis groups (mRS 0-1, OR= 1.53, 95% CI: 1.31~1.79, Z=5.40, P <0.00001; mRS 0-2, OR= 1.33, 95% CI: 1.07~1.65, Z=2.59, P =0.01). (2) Safety: There was no significant difference in the recurrence rate of stroke or mortality between the two groups ( recurrence rate, OR= 0.62, 95% CI: 0.35~1.08, Z=1.68, P =0.09; mortality, OR=0.89, 95% CI: 0.45~1.77, Z=0.33, P =0.74). There were more patients with intracranial hemorrhage in intravenous thrombolysis group than in nonthrombolysis group (asymptomatic intracranial hemorrhage, OR= 2.39, 95% CI:1.19~4.80, Z=2.45, P =0.01; symptomatic intracranial hemorrhage, OR= 7.65, 95% CI:3.07~19.05, Z=4.37, P <0.0001). Conclusion: Intravenous thrombolysis significantly improved the functional outcomes but did not reduce mortality at 90 days in patients with acute mild stroke and had a higher risk of intracranial hemorrhage.