Efficacy of Tirofiban Administered at Different Time Points after Intravenous Thrombolytic Therapy with Alteplase in Patients with Acute Ischemic Stroke

Abstract

Objective: To evaluate the efficacy of tirofiban administered at different time points within 24 hours of intravenous thrombolysis with alteplase in acute ischemic stroke. Methods: Patients who underwent intravenous thrombolysis with alteplase and fulfilled other inclusion criteria were randomly divided into 4 groups according to the time points of tirofiban administration: Group A (2 h), Group B (2-12 h), Group C (12-24 h), and Group D (control). The changes in National Institutes of Health Stroke Scale score, modified Rankin Scale score, and adverse events were analyzed. Results: At 7 § 1 day, the efficacy in Group A was better than that in Group C (P = .006) and Group D (P = .001), but there was no significant difference in the efficacy between Groups A and B (P = .268). Similarly, at 14 § 2 d, the efficacy in Group A was better than that in Group C (P = .026) and Group D (P = .001), but there was no significant difference in the efficacy between Groups A and B (P = .394). As evaluated by the modified Rankin Scale, the prognosis in Groups A, B, and C was better than that in Group D (P = .042, .008, .027, respectively), which was unrelated to the time points of tirofiban administration. There was no significant difference in the incidence of adverse events among the four groups. Conclusions: Tirofiban combined with alteplase is effective and safe, and particularly beneficial when administered at 2 hour and 2-12 hours after intravenous thrombolysis with alteplase in acute ischemic stroke.

The safety and effectiveness of early anti-platelet therapy after alteplase for acute ischemic stroke: A meta-analysis

“…After screening, 15 RCTs(Randomized Controlled Trials) needed to be evaluated in detail, 2 of which are retrospective studies [6,7]; 1 is a historical controlled study [8], 1 is a post-hoc trend matching analysis study of a randomized clinical trial [9], 6 study designs are not suitable [10][11][12][13][14][15]; 1 study population does not meet the inclusion requirements [16]; 1 with very short follow-up time, and has no 90-day efficacy evaluation [17]. Finally, 3 RCTs were included in our analysis [18][19][20] (Fig. 1).…”

“…Some of these studies have shown that early use of antiplatelet-aggregation drugs is beneficial to patients. However, previous clinical studies suggested that the early application of antiplatelet-aggregation drugs caused increased risk of cerebral hemorrhage [20]. The current clinical guidelines do not recommend the use of anti-platelet drugs within 24 h after thrombolysis.…”

“…Therefore, early use of antiplatelet-aggregation drugs after intravenous thrombolysis may be helpful in reducing vascular occlusion. With the increasing popularity of intravenous thrombolysis in cerebral infarction and the application of new anti-platelet-aggregation drugs, a new series of clinical studies have emerged to compare the efficacy of using anti-platelet-aggregation drugs in the early stage (within 24 h) with routine (after 24 h) after intravenous thrombolysis [7][8][9][19][20][21][22]. Some of these studies have shown that early use of antiplatelet-aggregation drugs is beneficial to patients.…”

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

“…In AIS patients receiving EVT, studies have also demonstrated that the use of tirofiban could not increase the proportion of patients with mRS 0–2 at 3 months [ 9 , 10 , 23 – 30 ]. Studies failed to reach a consensus about whether the efficacy of tirofiban was superior in patients receiving IVT with alteplase [ 31 , 32 ].…”

“…There was no significant difference in the incidence of ICH between the two groups. Several studies have also demonstrated that the combination of tirofiban and other standard cares did not increase the risk of ICH [ 13 , 31 , 33 ]. It can be inferred that the administration of tirofiban instead of dual antiplatelet is relatively safe in AIS patients who had fulfilled the inclusion criteria.…”