Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease

Liu, Bin; Zhang, Hong; Wang, Rong; Qu, Hongdang; Sun, Yifei; Zhang, Wanlong; Zhang, Shuye

doi:10.1177/0300060520926298

Cited by 17 publications

(13 citation statements)

References 32 publications

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“…Additionally, administration within 2 hours and 2-12 hours from one enrolled study is more bene cial 11 , thus, a window of < 12 hours might be feasible. According to the available research, tiro ban is bene cial for branch atheromatous disease and large artery atherosclerosis [24][25][26] , however, these bene cial effects may not be applicable for cases of cardio-embolic stroke. Only two of the studies included in the present meta-analysis referenced subtypes of ischemic stroke and did not further investigate variations in tiro ban e cacy in ischemic stroke subtypes of different etiologies 1,11 .…”

Section: Discussionmentioning

confidence: 99%

Early intravenous administration of tirofiban is recommended in patients with acute ischemic stroke treated with alteplase: a meta-analysis

Huo

Yang

Zhou

et al. 2023

Preprint

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Background: The occurrence of early neurological deterioration (END) following intravenous thrombolysis (IVT) is considered a particularly ominous clinical event and is strongly correlated with poor outcomes. Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes. However, the rationality of this remedy is a controversial. The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke (AIS). Methods: Databases including PubMed, EMBASE, Cochrane Library, and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022. Odds ratios (ORs) were generated for dichotomous variants via meta-analysis using STATA 17.0 MP. Results: Five clinical trials with 725 patients were eligible. The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage (Odds ratios [OR], 0.78; 95%confidence interval [CI], 0.22 - 2.74; P=0.70), asymptomatic intracranial hemorrhage (OR, 1.11; 95%CI, 0.52 - 2.37; P=0.80), systemic bleeding (OR, 0.97; 95%CI, 0.42 - 2.23; P=0.94), and death (OR, 1.05; 95%CI, 0.47 - 2.31; P=0.91), but may reduce the incidence of END (OR, 0.09; 95% CI, 0.02 - 0.50; P=0.01), and was significantly associated with 90-day excellent (modified Rankin scale[mRS] score 0–1) (OR, 2.01; 95% CI, 1.35 - 3.02; P=0.00) and favorable (mRS score 0–2) (OR, 2.30; 95% CI, 1.63 - 3.23; P=0.00) functional outcomes. Conclusion: The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.

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Section: Discussionmentioning

confidence: 99%

Early intravenous administration of tirofiban is recommended in patients with acute ischemic stroke treated with alteplase: a meta-analysis

Huo

Yang

Zhou

et al. 2023

Preprint

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“…Strategies to prevent the occurrence of END are currently an important topic. Several recent studies indicated that early intensive antiplatelet or anticoagulation therapy may reduce the risk of END and improve the clinical prognosis of patients [11,[28][29][30][31]. The study by Liu et al with a small sample size (n = 17) showed that early administration of tirofiban after intravenous thrombolysis with urokinase reduced the incidence of END within 3 days from onset in patients with BAD (P = 0.004) [31].…”

Section: Discussionmentioning

confidence: 99%

“…Several recent studies indicated that early intensive antiplatelet or anticoagulation therapy may reduce the risk of END and improve the clinical prognosis of patients [11,[28][29][30][31]. The study by Liu et al with a small sample size (n = 17) showed that early administration of tirofiban after intravenous thrombolysis with urokinase reduced the incidence of END within 3 days from onset in patients with BAD (P = 0.004) [31]. Recently, our observational study showed that short-term application of dual antiplatelet therapy plus argatroban seemed safe and effective at preventing END in patients with BAD [11].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for early neurological deterioration in acute isolated pontine infarction without any causative artery stenosis

Liu

Peng²,

Wang

et al. 2022

BMC Neurol

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Background This study aimed to investigate the risk predictors for early neurological deterioration (END) in isolated acute pontine infarction without any causative artery stenosis. Methods In this retrospective study, patients with isolated acute pontine infarction within 72 h of symptom onset were enrolled between October 2017 and December 2021. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) score ≥ 2 points within the first week postadmission. Patients were divided into the END and the non-END groups. Multiple logistic regression analysis was used to evaluate independent predictors of END in patients with isolated acute pontine infarction. Results A total of 153 patients were included in the final study (62 females; mean age, 67.27 ± 11.35 years), of whom 28.7% (47 of 153) experienced END. Multiple logistic regression analyses showed that infarct volume (adjusted odds ratio [aOR], 1.003; 95% CI, 1.001–1.005; P = 0.002) and basilar artery branch disease (aOR, 3.388; 95% CI, 1.102–10.417; P = 0.033) were associated with END. The combined ROC analysis of the infarct volume and basilar artery branch disease for predicting END showed that the sensitivity and specificity were 80.9% and 72.6%, respectively. Conclusion Basilar artery branch disease and infarct volume were associated with END in acute isolated pontine infarction and may be useful prognostic factors for neurological progression.

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“…Previous study found that dual-antiplatelet or anticoagulation therapy might reduce END, but their effect on BAD-related stroke remained unclear and might increase the risk of bleeding [21,22]. Tirofiban also showed efficacy on reducing END and improving outcomes in patients with endovascular therapy, intravenous thrombolysis or BAD-related stroke, but warranting further confirmation in large-sample patients with BAD-related stroke [23][24][25]. The optimal regimen for reducing END and improving outcome remains inconclusive [19].…”

Section: Introductionmentioning

confidence: 99%

Study protocol of Branch Atheromatous Disease-related stroke (BAD-study): a multicenter prospective cohort study

Fan

et al. 2022

BMC Neurol

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Background As a meaningful subtype of ischemic stroke in Asians, Branch atheromatous disease (BAD)-related stroke is associated with high early neurological deterioration (END) and disability, but is understudied and without recommended therapy. The mechanism of END still remains unclear. Branch atheromatous disease-related stroke study (BAD-study) therefore aims to investigate demographic, clinical and radiological features, and prognosis of BAD-related stroke in Chinese patients. Methods/design BAD-study is a nationwide, multicenter, consecutive, prospective, observational cohort study enrolling patients aged 18–80 years with BAD-related stroke within 72 h after symptom onset. Initial clinical data, laboratory tests, and imaging data are collected via structured case report form, and follow-ups will be performed at 7 days, 30 days, 90 days, 6 months and 12 months after enrollment. The primary outcome is the score on modified Rankin Scale at 90-day follow-up with single-blinded assessment. Secondary outcomes include END within 7 days, and National institute of health stroke scale score, Barthel index, cerebrovascular events, major bleeding complications, and all-cause mortality during 90-day follow-up. Characteristics of penetrating and parent artery will be assessed by high-resolution magnetic resonance imaging combined with other imaging techniques. Discussion BAD-study can provide demographic, clinical, radiological, and prognostic characteristics of BAD-related stroke, and thereby potentially figure out the vascular mechanism of early neurological deterioration and optimize therapy strategy with the aid of advanced imaging technique. Baseline data and evidence will also be generated for randomized controlled trials on BAD-related stroke in the future.

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Early administration of tirofiban after urokinase-mediated intravenous thrombolysis reduces early neurological deterioration in patients with branch atheromatous disease

Cited by 17 publications

References 32 publications

Early intravenous administration of tirofiban is recommended in patients with acute ischemic stroke treated with alteplase: a meta-analysis

Early intravenous administration of tirofiban is recommended in patients with acute ischemic stroke treated with alteplase: a meta-analysis

Risk factors for early neurological deterioration in acute isolated pontine infarction without any causative artery stenosis

Study protocol of Branch Atheromatous Disease-related stroke (BAD-study): a multicenter prospective cohort study

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