Half bolus dose of intravenous abciximab is safe and effective in the setting of acute stroke endovascular treatment

Delgado, Fernando; Oteros, Rafael; Jimenez-Gomez, Elvira; Rey, Isabel Bravo; Bautista, María Dolores; Moyano, Roberto Valverde

doi:10.1136/neurintsurg-2018-014163

Cited by 14 publications

(15 citation statements)

References 14 publications

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“…The effect was appreciably faster if thrombosis was limited, far slower if stent was completely occluded, similarly to other literature reports [21]. AntiGP2b3a are contraindicated in patients with brain lesions as they may increase incidence or eventually worsen intracranial hemorrhage [22], although they have been reported as safe in acute ischemic stroke [23] and in SAC of ruptured [24] and unruptured aneurysms [25]. In our opinion, the presence of stent thrombosis represents a robust justification for off-label drugs administration despite contraindication.…”

Section: Discussionsupporting

confidence: 75%

Neuroform Atlas stent-assisted coiling of ruptured intracranial aneurysms: A multicenter study

Russo

Bradač

Castellan

et al. 2021

Journal of Neuroradiology

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Section: Discussionsupporting

confidence: 75%

Neuroform Atlas stent-assisted coiling of ruptured intracranial aneurysms: A multicenter study

Russo

Bradač

Castellan

et al. 2021

Journal of Neuroradiology

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“…There were five (41.7%) women, mean age of the cohort was 67.9 ± 12, and median ASPECT/pc-ASPECT score was 9.5 (IQR 9-10). Median NIHSS on presentation was 15 (13)(14)(15)(16)(17)(18)(19)(20)(21), seven (58.3%) patients received intravenous tPA, and all patients achieved successful reperfusion (TICI 2b or greater) (Table 2 describes individual characteristic & treatment variables).…”

Section: Resultsmentioning

confidence: 99%

Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series

et al. 2021

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Background: Neurointerventional procedures in acute ischemic stroke often require immediate antiplatelet therapy in the cases of acute stenting and occasionally re-occluding vessels. Intravenous cangrelor is a P2Y12 receptor antagonist with short onset and quick offset. The study objective was to evaluate the safety and efficacy of intravenous cangrelor in patients with acute ischemic stroke requiring urgent antiplatelet effect.Methods: Patients who received intravenous cangrelor intra-procedurally during acute ischemic stroke treatment were identified from a prospectively collected database. Cangrelor was administered as a bolus of 15 mcg/kg, followed by an infusion rate of 2 mcg/kg/min. A historical control group consisting of anterior circulation tandem occlusions was used to compare to patients with similar lesions who received intravenous cangrelor. Outcomes of interest included in-stent thrombosis, thromboembolic complications, intracranial hemorrhage, and functional outcomes at 90 days.Results: Twelve patients received intravenous cangrelor for acute ischemic stroke between October 2018 and April 2020 at a comprehensive stroke center. Eleven patients had intra or extracranial stenting performed, which included two posterior circulation lesions. No cases of symptomatic intracranial hemorrhage were reported. At 90 day follow-up, two patients had died and 10 had a good functional outcome. Patients with anterior circulation tandem occlusions who received cangrelor and those who received dual antiplatelets orally had similar radiographic and clinical outcomes.Conclusion: Low dose intravenous cangrelor is similar in safety and efficacy to oral antiplatelets in acute ischemic stroke in a small case series. Larger prospective studies on the efficacy, safety, and effect on procedure times of intravenous cangrelor in neurointervention are warranted.

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“…Several previous studies also observed that endovascular treatment (EVT) alone has no absolute superiority over tirofiban combined with EVT in terms of safety (10–12, 15). Moreover, two recent studies that assessing the safety of abciximab (another approved GP IIb/IIIa inhibitors) combined with EVT concluded that abciximab treatment may be relatively safe (16, 17). Al-Mufti et al found that abciximab administration after emergent carotid stenting caused no death at 3-month follow-up (16).…”

Section: Discussionmentioning

confidence: 99%

“…Al-Mufti et al found that abciximab administration after emergent carotid stenting caused no death at 3-month follow-up (16). And among all 99 patients treated with abciximab that Delgado et al retrospectively assessed, no sICH was occurred (17). When compared with abciximab, tirofiban have a lower molecular weight and a shorter half-life, hence, tirofiban can penetrate into the thrombus easily and reduced platelet function can be normalized very shortly after the end of tirofiban administration (18).…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Tirofiban Combined With Mechanical Thrombectomy Depend on Ischemic Stroke Etiology

Sun

Zhao

et al. 2019

Front. Neurol.

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Background and Purpose: The clinical use of tirofiban for patients with acute ischemic stroke (AIS) who underwent mechanical thrombectomy (MT) remains controversial. We aimed to evaluate the safety and efficacy of tirofiban combined with MT in AIS patients.Methods: Patients with AIS who underwent MT from January 2014 to December 2018 were enrolled in three stroke units in China. Subgroup analyses were performed based on stroke etiology which was classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Safety outcomes were in-hospital intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH) and mortality at 3-month. Efficacy outcomes were favorable functional outcome and functional independence at 3-month and neurological improvement at 24 h, 3 d and discharge.Results: In patients with large artery atherosclerosis (LAA) stroke, multivariate analyses revealed that tirofiban significantly decreased the odds of in-hospital ICH (adjusted OR = 0.382, 95% CI 0.180–0.809) and tended to increase the odds of favorable functional outcome at 3-month (adjusted OR = 3.050, 95% CI 0.969–9.598). By contrast, in patients with cardioembolism (CE) stroke, tirofiban was not associated with higher odds of favorable functional outcome at 3-month (adjusted OR = 0.719, 95% CI 0.107–4.807), but significantly decreased the odds of neurological improvement at 24 h and 3d (adjusted OR = 0.185, 95% CI 0.047–0.726; adjusted OR = 0.268, 95% CI 0.087–0.825).Conclusions: Tirofiban combined with MT appears to be safe and effective in LAA patients, but has no beneficial effect on CE patients.

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Half bolus dose of intravenous abciximab is safe and effective in the setting of acute stroke endovascular treatment

Abstract: In the endovascular treatment of acute ischemic stroke, a bolus dose of 0125 mg/kg of abciximab with no maintenance doses, followed by 150 mg of aspirin and 75 mg of clopidogrel orally the next day, is safe and effective.

Cited by 14 publications

References 14 publications

Neuroform Atlas stent-assisted coiling of ruptured intracranial aneurysms: A multicenter study

Neuroform Atlas stent-assisted coiling of ruptured intracranial aneurysms: A multicenter study

Safety of Low Dose Intravenous Cangrelor in Acute Ischemic Stroke: A Case Series

Safety and Efficacy of Tirofiban Combined With Mechanical Thrombectomy Depend on Ischemic Stroke Etiology

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