Association between tirofiban monotherapy and efficacy and safety in acute ischemic stroke

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.

The efficacy and safety of tirofiban versus oral antiplatelet drug therapy in acute ischemic stroke patients with early neurological deterioration

“…Torgano et al reported that the functional outcome at 90 days, mortality and symptomatic intracranial hemorrhage were comparable between tiro ban and aspirin group [23]. In the study of Tao et al, tiro ban alone was noninferior to DAPT with regard to 90-day mRS [24], while another study by Wang et al showed that tiro ban performed better than DAPT in 90-day mRS and the occurrence of END [25]. The e cacy of tiro ban in AIS remains to be elucidated.…”

Tirofiban for Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis: A Systematic Review and Meta-Analysis

“…The SaTIS (Safety of Tirofiban in Acute Ischemic Stroke) trial showed that tirofiban alone did not increase the risk of cerebral infarction hemorrhage or parenchymal hemorrhage and significantly reduced mortality rates [22]. Tirofiban could reduce the rate of ICH and mortality even when compared with standard dual antiplatelet therapy [23].…”

Factors affecting the outcomes of tirofiban after endovascular treatment in acute ischemic stroke: Experience from a single center

“…Intravenous recombination tissue plasminogen activator (rt‐PA) has been widely recommended as a standard treatment for acute ischemic stroke (AIS) in most clinical practice guidelines 2 . However, only about 5%–20% of AIS patients received rt‐PA treatment, which is restricted by the narrow therapeutic time window, and only 2% of stroke patients could be beneficial from this treatment regimen 3,4 . Endovascular intervention can restore blood flow promptly, and thrombectomy with stent retrievers is now recommended as the standard care for AIS with a proximal large vessel occlusion (LVO) 5,6 .…”

“… 2 However, only about 5%–20% of AIS patients received rt‐PA treatment, which is restricted by the narrow therapeutic time window, and only 2% of stroke patients could be beneficial from this treatment regimen. 3 , 4 Endovascular intervention can restore blood flow promptly, and thrombectomy with stent retrievers is now recommended as the standard care for AIS with a proximal large vessel occlusion (LVO). 5 , 6 However, as inherent damage to the endothelial cells lining of a blood vessel, endovascular treatment (EVT), such as mechanical thrombectomy (MT), angioplasty, and stenting, lead to local platelet aggregation, contributing to subsequent early reocclusion and thromboembolic complications.…”