Efficacy outcomes and safety measures of intravenous tirofiban or eptifibatide for patients with acute ischemic stroke: a systematic review and meta-analysis of prospective studies

Liu, Jingting; Yang, Yali; Liu, Hongbo

doi:10.1007/s11239-021-02584-3

Cited by 17 publications

(12 citation statements)

References 47 publications

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“…It seems associated with good function at 3 months (Li et al, 2016;Wu et al, 2019). A retrospective analysis of patients with ischemic stroke in Korea also found no increased risk of hemorrhage with early initiation of antiplatelet or anticoagulant therapy (<24 h) after intravenous alteplase or endovascular treatment compared with initiation at >24 h (Liu et al, 2022). Tirofiban inhibits platelet aggregation within 5 min after intravenous injection and reaches the peak time (Dornbos et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy of tirofiban after early neurological deterioration in patients with branch atheromatous disease receiving alteplase

Zhong

Zhao

et al. 2022

Front. Stroke

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ObjectivesNo standard treatment exists for branch atheromatous disease (BAD), and patients' conditions often worsen after thrombolytic therapy. We evaluated the safety and effectiveness of tirofiban after early neurological deterioration (END) development in patients receiving intravenous alteplase.Materials and methodsBleeding incidence, National Institute of Health Stroke Scale (NIHSS) score, and modified Rankin scale (mRS) score were assessed for patients with BAD receiving alteplase within 4.5 h of stroke onset.ResultsAmong 193 patients, 119 (61.64%) did not experience exacerbation after thrombolytic treatment, 74 (38.34%) had END, 34 were treated with tirofiban after END, and 40 received standard treatment. On day 7 or at discharge, no cases of symptomatic cerebral hemorrhage were noted, and no patient died during the 90-day follow-up. Fifty-two of 74 patients (70.27%) had a good mRS score at 90 days. Among patients with END who received tirofiban, 27 (79.41%) had a good mRS score at 90 days, which was significantly better than that of the 18 cases that did not receive tirofiban after exacerbation (45%; P < 0.001). NIHSS scores were significantly lower 24 h, 48 h, and 7 days after tirofiban treatment in patients with exacerbation after thrombolytic therapy than in those without tirofiban treatment.ConclusionsPatients with BAD have elevated risks of END after thrombolytic therapy. Compared with conventional oral antiplatelet aggregation drugs, tirofiban rescue therapy resulted in significantly better NIHSS and mRS scores without increased symptomatic cerebral hemorrhage rates.

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Section: Discussionmentioning

confidence: 99%

Safety and efficacy of tirofiban after early neurological deterioration in patients with branch atheromatous disease receiving alteplase

Zhong

Zhao

et al. 2022

Front. Stroke

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“…62 These results validate a remarkably similar safety profile of standard-dose rtPA and eptifibatide that creates the basis of phase 3 trial with full-dose rtPA combined with eptifibatide. However, Liu et al 63 reported that eptifibatide did not improve functional outcome with thrombolysis or thrombectomy.…”

Section: Antiplatelet Agentmentioning

confidence: 99%

Pharmacological Strategies for Stroke Intervention: Assessment of Pathophysiological Relevance and Clinical Trials

et al. 2022

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Objectives:The present review describes stroke pathophysiology in brief and discusses the spectrum of available treatments with different promising interventions that are in clinical settings or are in clinical trials.Methods: Relevant articles were searched using Google Scholar, Cochrane Library, and PubMed. Keywords for the search included ischemic stroke, mechanisms, stroke interventions, clinical trials, and stem cell therapy. Results and Conclusion:Stroke accounts to a high burden of mortality and morbidity around the globe. Time is an important factor in treating stroke. Treatment options are limited; however, agents with considerable efficacy and tolerability are being continuously explored. With the advances in stroke interventions, new therapies are being formulated with a hope that these may aid the ongoing protective and reparative processes. Such therapies may have an extended therapeutic time window in hours, days, weeks, or longer and may have the advantage to be accessible by a majority of the patients.

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“…The effect of platelet aggregation blockade of tirofiban is dose‐dependent and can be rapidly reversible in 1.5–2.2 h 12 . Several studies have evaluated the efficacy of tirofiban in patients receiving EVT 13,14 . However, fewer studies have focused on the factors affecting the outcomes of the EVT followed by tirofiban in AIS patients.…”

Section: Introductionmentioning

confidence: 99%

“… 10 , 11 The effect of platelet aggregation blockade of tirofiban is dose‐dependent and can be rapidly reversible in 1.5–2.2 h. 12 Several studies have evaluated the efficacy of tirofiban in patients receiving EVT. 13 , 14 However, fewer studies have focused on the factors affecting the outcomes of the EVT followed by tirofiban in AIS patients. In this study, we performed exploratory analyses regarding factors influencing functional outcomes in AIS patients who received adding tirofiban to EVT.…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Zhang

et al. 2023

CNS Neurosci Ther

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Aims To investigate the predicted factors influencing the outcomes in acute ischemic stroke (AIS) patients who received tirofiban after endovascular treatment (EVT) and the optimal administration of tirofiban. Methods In this retrospective study, AIS patients who received EVT followed by tirofiban between January 2017 and October 2021 were enrolled. The dose and duration of tirofiban were adjusted by trained clinicians according to the patient's clinical status. A reduction of at least four points on the National Institutes of Health Stroke Scale (NIHSS) after tirofiban compared with that before tirofiban was defined as an effective response. A modified ranking scale (mRS) of 0–2 was defined as a favorable outcome at a 90‐day follow‐up. Results A total of 260 consecutive patients were enrolled, and 36.5% of patients achieved a favorable outcome. The modified thrombolysis in cerebral infarction (mTICI) 2b‐3 occurred in 93.5% of patients. Symptomatic intracerebral hemorrhage (sICH) occurred in 6.2% of patients, and the mortality at 90‐day follow‐up was 16.9%. Duration of tirofiban >24 h (adjusted OR: 2.545; 95% CI: 1.008–6.423; p = 0.048) and effective response to tirofiban (adjusted OR: 25.562; 95% CI: 9.794–66.715; p < 0.001) were related to the favorable outcome (mRS 0–2). Higher NIHSS (adjusted OR: 0.855; 95% CI: 0.809–0.904; p < 0.001) and glucose level on admission (adjusted OR: 0.843; 95% CI: 0.731–0.971; p = 0.018) were predictive for the unfavorable outcome (mRS 3–6). Conclusions An effective response to tirofiban is an independent factor in predicting the long‐term efficacy outcome, and extending the duration of tirofiban is beneficial for neurological improvement.

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Efficacy outcomes and safety measures of intravenous tirofiban or eptifibatide for patients with acute ischemic stroke: a systematic review and meta-analysis of prospective studies

Cited by 17 publications

References 47 publications

Safety and efficacy of tirofiban after early neurological deterioration in patients with branch atheromatous disease receiving alteplase

Safety and efficacy of tirofiban after early neurological deterioration in patients with branch atheromatous disease receiving alteplase

Pharmacological Strategies for Stroke Intervention: Assessment of Pathophysiological Relevance and Clinical Trials

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

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