Thrombolysis With Recombinant Tissue Plasminogen Activator and Tirofiban in Stroke

Abstract

Background and Purpose-We sought to investigate the feasibility of the combined use of low-dose recombinant tissue plasminogen activator (rtPA) and tirofiban, a glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonist, for systemic thrombolysis in acute stroke. Methods-Consecutive patients who were treated with systemic application of low-dose rtPA and body weight-adjusted tirofiban (rtPAϩT group; nϭ37) were evaluated retrospectively during 1999 -2001. Patients in the rtPAϩT group were compared with a group of patients treated with a dose of 0.9 mg/kg body weight in a different center (rtPA group; nϭ119). The 41 patients with infarctions of the middle cerebral artery territory who were not eligible for thrombolytic treatment because of medical contraindications or arrival in the hospital Ͼ3 hours after stroke onset served as controls. For matched comparisons, the National Institutes of Health Stroke Scale on admission and the Rankin Scale on discharge 5 days after stroke were used. Results-The patients treated with rtPAϩT or rtPA improved (PϽ0.05) compared with the controls at discharge; patients in the rtPAϩT and rtPA groups reached a Rankin Scale score of 0 to 2 in 63% and 55%, respectively, while only 16% of the controls achieved this score. Death rates (8% in rtPAϩT group and 5% in rtPA group) were similar among the 2 treatment groups. They included 1 fatal hemorrhage in the rtPAϩT group and 4 fatal hemorrhages in the rtPA group. Five percent of the untreated patients developed symptomatic, nonfatal cerebral hemorrhage. Conclusions-Systemic combined thrombolysis with rtPAϩT seems to be a feasible treatment in acute stroke.

Systemic Thrombolysis With Recombinant Tissue Plasminogen Activator and Tirofiban in Acute Middle Cerebral Artery Occlusion

“…9,10 Present clinical studies suggest that GPIIb/IIIa antagonists may carry a relatively low risk for intracerebral bleeding in acute ischemic stroke patients. [11][12][13] The high reperfusion potential of combined systemic thrombolysis with rtPA at reduced dosages and the nonpeptide platelet GPIIb/IIIa antagonist tirofiban in basilar artery thrombosis 14 prompted us to investigate the feasibility of this new treatment strategy in the setting of acute middle cerebral artery (MCA) occlusion with respect to recanalization, ischemic lesion evolution, clinical course, and cerebral bleeding complications.…”

Combining Intravenous Thrombolysis and Antithrombotic Agents in Stroke: An Update

“…Patients reached a Rankin Scale score of 0 to 2 in 63%. The death rate was 8% and 1 fatal hemorrhage was observed 18. In a small open‐label trial, 19 patients with acute middle cerebral artery occlusion underwent combined intravenous thrombolytic treatment using rtPA at reduced dosages and body weight–adjusted tirofiban for at least 48 hours.…”

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“…A phase-III-study, however, had to be stopped due to an increased bleeding rate and no sufficient efficacy (Adams et al 2008). For the competitive receptor antagonist tirofiban until now only smaller studies without safety concerns are available, also in combination with rtPA (Junghans et al 2001, Seitz et al 2003) -further studies are pending (SATIS). However, one has to assume that in these studies the bleeding complications will outweigh the therapeutical benefit, too.…”