Safety and efficacy of tirofiban combined with endovascular treatment in acute ischaemic stroke

Pan, Xiding; Zheng, Danni; Zheng, Yin; Chan, Po-Chi; Lin, Yu-Ting; Zou, Jianjun; Zhou, Junshan; Yang, Jianhong

doi:10.1111/ene.13946

Cited by 46 publications

(42 citation statements)

References 24 publications

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“…DOI: 10.1159/000509054 stent retriever trials which confirmed the effect of ET in selected patients with AIS [1][2][3][4][5][6], whereas Kellert et al [13] conducted the study before 2015 and concluded that tirofiban was associated with increased risk of fatal ICH and poor outcome. However, the results of Zhao et al [20] and Pan et al [16], conducted after 2015, were quite the contrary. (2) Discretion of interventionists: the use of tirofiban was at the discretion of interventionists who may be prone to use tirofiban in subjects with heavier atherosclerotic burden and high possibility of reocclusion after the occluded arteries were partially recanaliazed or ultimately achieved good reperfusion.…”

Section: Discussionmentioning

confidence: 90%

“…We retrieved 1,213 articles that were potentially pertinent. After removing duplicates and reviewing titles and abstracts to exclude irrelevant studies, case reports, and reviews, 11 cohort trials [10][11][12][13][14][15][16][17][18][19][20] fulfilled all the inclusion criteria and included 2,028 patients ( Fig. 1).…”

Section: Search Resultsmentioning

confidence: 99%

“…It may explain why rescue tirofiban, indeed effective, cannot be demonstrated to be able to improve recanalization rate and favorable functional outcomes. Second, update of technical materials: all subjects in Zhao et al [20] and Pan et al [16] were treated with second-generation stent retriever device using improved thrombectomy technique, whereas almost 20% of subjects of Kellert et al [13] used others (e.g., balloon expansion technique, merci retriever, and stent implantation) which may have led to lower recanalization rate and poor outcome [29]. Third, the dose of tirofiban (Zhang et al [19] and Yu et al [18]) indicated that a low dose of tirofiban with an intra-arterial bolus followed by continuous intravenous administration may lower the incidence of sICH.…”

Section: Discussionmentioning

confidence: 99%

“…However, as an off-label usage, Cerebrovasc Dis 2020;49:442-450 DOI: 10.1159/000509054 whether tirofiban increases the bleeding risk or improves the outcome of ET in AIS is unknown. There were several studies that evaluated the feasibility of tirofiban in AIS patients receiving ET, and the results were conflicting [10][11][12][13][14][15][16][17][18][19][20]. Thus, we aimed to perform a meta-analysis to evaluate the safety and efficacy of tirofiban in combination with ET for AIS patients.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Efficacy of Tirofiban in Acute Ischemic Stroke Patients Receiving Endovascular Treatment: A Meta-Analysis

Liu

et al. 2020

Cerebrovasc Dis

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Objectives: Tirofiban is widely used in clinical practice for acute ischemic stroke (AIS). However, whether tirofiban increases the bleeding risk or improves the outcome of AIS patients with endovascular treatment (ET) is unknown. The aim of this meta-analysis is to evaluate the safety and efficacy of tirofiban compared with those without tirofiban in AIS patients receiving ET. Methods: Systematic literature search was done in PubMed and EMBASE databases without language or time limitation. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Efficacy outcomes were recanalization rate and favorable functional outcome. Review Manager 5.3 and Stata Software Package 15.0 were used to perform the meta-analysis. Results: Eleven studies with a total of 2,028 patients were included. A total of 704 (34.7%) patients were administrated tirofiban combined with ET. Meta-analysis suggested that tirofiban did not increase the risk of sICH (odds ratio (OR) 1.08; 95% confidence interval (CI) 0.81-1.46; p = 0.59) but significantly decreased mortality (OR 0.68; 95% CI 0.52-0.89; p = 0.005). There was no association between tirofiban and recanalization rate (OR 1.26; 95% CI 0.86-1.82; p = 0.23) or favorable functional outcome (OR 1.21; 95% CI 0.88-1.68; p = 0.24). Subgroup analyses indicated that preoperative tirofiban significantly increase recanalization rate (OR 3.89; 95% CI 1.70-8.93; p = 0.001) and improve favorable functional outcome (OR 2.30; 95% CI 1.15-4.60; p = 0.02). Conclusions: Tirofiban is safe in AIS patients with ET and can significantly reduce mortality; preoperative tirofiban may be effective, but further studies are needed to confirm the efficacy.

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Section: Discussionmentioning

confidence: 90%

Section: Search Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety and Efficacy of Tirofiban in Acute Ischemic Stroke Patients Receiving Endovascular Treatment: A Meta-Analysis

Liu

et al. 2020

Cerebrovasc Dis

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“…According to multivariate regression analysis, tirofiban was not associated with the risk of sICH and mortality at 3-month. 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).…”

Section: Discussionmentioning

confidence: 98%

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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Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke

Shuai

Gong

et al. 2022

JAMA

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RESCUE BT Trial Investigators E ndovascular treatment has been shown to significantly increase the reperfusion rate and improve the functional outcomes of patients with acute ischemic stroke due to large vessel occlusion. [1][2][3][4] However, endovascular thrombectomy has historically failed to yield successful reperfusion in approximately 30% of patients. 5 Unsuccessful reperfusion likely arises in part from mechanical thrombectomy devices causing traumatic damage to the vascular endothelium with subendothelial matrix exposure, leading to platelet activation, adhesion, and aggregation and potentially resulting in reocclusion and thromboembolic complications. 6,7 Tirofiban, a highly selective nonpeptide platelet glycoprotein IIb/IIIa inhibitor with a relatively short half-life that can reversibly prevent platelet aggregation, has been proven to reduce the risk of thrombotic complications during percutaneous coronary intervention. [8][9][10] Given the benefit of treatment of acute coronary syndromes, a growing number of studies have evaluated tirofiban as an adjunctive treatment in patients with large vessel occlusion ischemic stroke IMPORTANCE Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor, which reversibly inhibits platelet aggregation. It remains uncertain whether intravenous tirofiban is effective to improve functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy.OBJECTIVE To assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion.DESIGN, SETTING, AND PARTICIPANTS This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 55 hospitals in China, enrolling 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well.

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Safety and efficacy of tirofiban combined with endovascular treatment in acute ischaemic stroke

Cited by 46 publications

References 24 publications

Safety and Efficacy of Tirofiban in Acute Ischemic Stroke Patients Receiving Endovascular Treatment: A Meta-Analysis

Safety and Efficacy of Tirofiban in Acute Ischemic Stroke Patients Receiving Endovascular Treatment: A Meta-Analysis

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

Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke

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