Progressive Ischemic Stroke: Clinical Features and Evaluation of Short-and Long- Term Tirofiban Therapy

Abstract

OBJECTIVE: Progressive ischemic stroke is a disorder frequently seen in neurological intensive care unit and stroke units. The purpose of this retrospective study was to evaluate the clinical features of progressive ischemic stroke patients in neurological intensive care unit, the short-and long-term efficacy of tirofiban therapy, and the adverse events observed. METHODS: The study included patients with minor-moderate progressive ischemic stroke diagnosed in the period between January and December 2014. The National Institute of Health Stroke Scale scores at 24 hours after tirofiban therapy and on discharge, and the modified Rankin score and Barthel Index value at the end of the 3. month were recorded from the patients' files. RESULTS: The study included a total of 28 patients, 15 (53.6%) of whom were males. The mean age of the cases was 65.36±11.32 (39-80). According to the TOAST classification, 10 cases had large vessel atherosclerosis, 9 had cardioembolism, and 9 had small vessel disease. When the groups were evaluated in terms of stroke subtypes, the NIHSS score was highest in the cardioembolic group and lowest in the small vessel disease group. The cases in the small vessel disease group demonstrated the most marked fall in NIHSS score. CONCLUSION: Tirofiban may be an alternative therapy for progressive ischemic stroke in case of proper selection of patients and under proper monitorization to detect side effects. Keywords: Barthel index, progressive ischemic stroke, Tirofiban. PROGRESİF İSKEMİK İNME: KLİNİK ÖZELLİKLER VE TİROFİBAN TEDAVİSİNİN KISA VE UZUN DÖNEM ETKİNLİĞİNİN DEĞERLENDİRİLMESİÖZET AMAÇ: Progresif iskemik inme nörolojik yoğun bakım ve inme ünitelerinde sıklıkla karşılaşılan bir klinik durumdur. Retrospektif olarak planlanan bu çalışmanın amacı progresif iskemik inmenin klinik özelliklerinin, tirofiban tedavisinin kısa ve uzun dönem etkinliğinin ve komplikasyonların değerlendirilmesidir. GEREÇ ve YÖNTEM: Ocak 2014-Aralık 2014 tarihleri arasında hafif ve orta şiddetli progresif iskemik inme tanısı alan hastalar çalışmaya alınmıştır. Hastaların dosya bilgilerinden tirofiban tedavisi ve taburculuk esnasında NIHSS skoru, 3. ayda ise modifiye Rankin skoru ve Barthel indeksi değerleri hesaplanmıştır. BULGULAR: Yirmi sekiz hastadan oluşan çalışmada 15 hasta(% 53,6) kadın idi. Hastaların yaş ortalaması 65,36 ± 11,32 (39-80) idi. TOAST sınıflamasına göre inme etiyolojileri 10 hastada büyük arter aterosklerozu, 9 hastada kardiyoembolizm ve 9 hastada küçük damar hastalığı olarak belirlendi. İnme etiyolojilerine göre değerlendirildiğinde NIHSS skoru kardiyoembolizm grubunda en yüksek iken küçük damar hastalığı grubunda en düşük olarak hesaplandı. Etiyolojide küçük damar hastalığı olan olgularda tedavi sonrası NIHSS skorundaki düşme en fazla olarak belirlendi. SONUÇ: Progresif iskemik inme hastalarında uygun hasta ve yan etkilerin dikkatli takibi ile tirofiban iyi bir tedavi alternatifi olabilir. Anahtar Sözcükler: Barthel indeksi, progresif iskemik inme, Tirofiban.

Efficacy of Intravenous Tirofiban Therapy in Lacunar Stroke Patients

“…27 In a case series published in our country, IV tirofiban treatment was given to 28 patients with progressive ischemic stroke (10 patients with large artery atherosclerosis, 9 patients with cardioembolism, 9 patients with small vessel disease); It was determined that the greatest decrease in the NIHSS score was in the small vessel disease group. 28 In the study reported by Zhang et al, which included patients with worsening under DAPT treatment, the patients were divided into 3 groups and followed up with tirofiban, tirofiban + ozagrel and ozagrel treatments. Although a decrease was observed in NIHSS scores in all three groups, the most significant decrease was observed in the tirofiban + ozagrel group at the 24th hour, 1st week and 2nd week.…”