Safety and Preliminary Efficacy of Early Tirofiban Treatment After Alteplase in Acute Ischemic Stroke Patients

Li, Wei; Lin, Li; Zhang, Meng; Wu, Ya; Liu, Chengchun; Li, Xiaoshu; Huang, Shuhan; Liang, Chun-Rong; Wang, Yanjiang; Chen, Jinhua; Feng, Wuwei

doi:10.1161/strokeaha.116.014413

Cited by 92 publications

(71 citation statements)

References 11 publications

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“…In these retrospective studies, tirofiban displayed adjuvant benefits in reperfusion, with relatively low risk of intracranial hemorrhage, and about 50% patients achieved favorable outcomes thanks to adjuvant tirofiban infusion. Moreover, Li et al (25) had demonstrated the safety and efficacy in a prospective study. Nonetheless, Kellert et al (26) cautioned about the risk of fatal intracerebral hemorrhage and poor outcome associated with tirofiban in endovascular stroke therapy.…”

Section: Discussionmentioning

confidence: 99%

Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS

Zhao

Zhang

Gu³

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to assess the use of tirofiban injections for rescue therapy following artery reocclusion due to intra-luminal thrombosis during endovascular thrombectomy in patients with acute ischemic stroke (AIS). A total of seven cases of patients treated with adjunctive tirofiban injections following failed endovascular thrombectomy due to instant intra-luminal thrombosis were retrospectively assessed. A Solitaire stent was used as the primary thrombectomy device in all patients. Tirofiban was injected intra-arterially via a temporarily deployed Solitaire stent with continuous intravenous infusion for the subsequent 24 h; half of the conventionally recommended dose was employed. Outcome measures included angiographic reperfusion (mTICI), symptomatic intracranial hemorrhage, mortality and functional independence at 90 days (modified Rankin Scale, 0-2). Six patients had occlusions in the middle cerebral artery and one patient had occlusions in the basilar artery. Of the seven patients, five exhibited successful reperfusion (mTICI 2b-3) and achieved functional independence following 90 days. Reperfusion failed in the remaining two patients, who succumbed within 90 days of therapy. No intracranial or extracranial hemorrhage cases were identified. The results of the present study suggest that tirofiban facilitates reperfusion and ameliorates long-term prognosis in patients with AIS undergoing endovascular thrombectomy, and may be safe for those receiving intravenous tissue plasminogen activator therapy.

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Section: Discussionmentioning

confidence: 99%

Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS

Zhao

Zhang

Gu³

et al. 2017

Experimental and Therapeutic Medicine

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“…Abciximab, the glycoprotein IIb/IIIa inhibitor, has an irreversible action on platelets, whilst other inhibitors, such as tirofiban and eptifibatide, have a reversible action and may reduce periprocedural hemorrhagic complications [28]. A recent open-label non-randomized study found that hemorrhagic complications did not increase in acute stroke patients who undertook 3 days of intravenous tirofiban infusion immediately following intravenous tissue plasminogen activator, compared to patients who were given intravenous tissue plasminogen activator only [29]. The use of glycoprotein IIb/IIIa inhibitors appears to be potential safe and effective treatment, although further randomized clinical trials are needed to confirm their efficacy.…”

Section: Therapeutic Strategy For Acute Icas-omentioning

confidence: 99%

Diagnostic and Therapeutic Strategies for Acute Intracranial Atherosclerosis-related Occlusions

2017

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Intracranial atherosclerosis-related occlusion (ICAS-O) is frequently encountered at the time of endovascular revascularization treatment (ERT), especially in Asian countries. However, because baseline angiographic findings are similar between ICAS-O and embolism-related occlusion (EMB-O), it is difficult to differentiate the etiologies before the ERT procedure. Moreover, despite successful randomized trials on ERT, results from studies examining the optimal treatment protocol in ICAS-O patients remain unclear. In this review, we describe the clinical and imaging factors that may possibly differentiate ICAS-O from EMB-O. We will also discuss some current hurdles for treating ICAS-O in the hyperacute period and suggest the optimal ERT strategy for ICAS-O patients.

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“…The progression occured on average 27.85 hours (6-72 hours) after the onset of stroke symptoms. The average NIHSS score at hour 1 of admission was 7.14 (2-6); the score at the time of progression occurence was 10.21 (5-21) with an average NIHSS increase of 3.07 (2-11); at 24 hours after administration of tirofiban, the score was 9.79 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and on discharge the score was 9.46 (1-18) (Figure 1). In the evaluation of the patient groups in terms of stroke subtypes, the NIHSS score was found to be highest in the cardioembolic stroke group and lowest in the small vessel disease group.…”

Section: Resultsmentioning

confidence: 99%

“…An evaluating preliminary study that included two patient groups which received Tirofiban + alteplase or only alteplase treatment has reported that when study group received tirofiban + alteplase treatment was compared to the study group which received only alteplase treatment, safe, feasible and potentially efficacious with improved outcomes were observed in study group which received tirofiban + alteplase treatment (11). In an another study which compared Tirofiban monotherapy, trombolytic treatment and interventional treatment, bleeding complication was not observed in tirofiban group but recanalization rate was found lowly (25%) compared to other groups (12).…”

Section: Discussionmentioning

confidence: 99%

“…The criteria for inclusion in the study were: presence of minor or medium-degree stroke on admission [with National Institute of Health Stroke Scale (NIHSS) score of [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], final diagnosis of PIS, age range of 18-80, contraindication for thrombolytic therapy, tirofiban use for therapy, and reachable control data at the end of the 3. month. The criteria for exclusion from the study were history of cerebral or extracerebral hemorrhage, known intracranial disease (such as arteriovenous malformation, neoplasm, aneurysm), liver disease, thrombocytopenia (platelet number <100.000), platelet dysfunction, major trauma, major surgery in the last 3 months, and past stroke; coagulopathy [prothrombin time (PT) >1.3 times of the normal and international normalized ratio (INR) >1.3].…”

Section: Methodsmentioning

confidence: 99%

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

Demır¹,

Balal²,

Pak³

et al. 2016

Türk Beyin Damar Hast Derg

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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.

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Safety and Preliminary Efficacy of Early Tirofiban Treatment After Alteplase in Acute Ischemic Stroke Patients

Abstract: URL: http://www.chictr.org.cn/. Unique identifier: ChiCTR-TRC-14004630.

Cited by 92 publications

References 11 publications

Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS

Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS

Diagnostic and Therapeutic Strategies for Acute Intracranial Atherosclerosis-related Occlusions

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

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