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Low-dose tirofiban may improve outcomes in endovascular therapy for stroke
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Patients with acute ischemic stroke who received combined treatment of endovascular thrombectomy and low-dose tirofiban showed lower rates of symptomatic intracerebral hemorrhage and mortality vs. those who received endovascular thrombectomy alone, according to results published in Stroke.
“The pathogenesis of the stroke in many Chinese patients with [acute ischemic stroke] is large artery atherosclerosis, and approximately half of them have intracranial artery stenosis. It may be much difficult to achieve good reperfusion with stent retrievers alone in these patients, therefore permanent stenting or balloon angioplasty is often used to achieve sufficient recanalization,” Wenbo Zhao, MD, from the department of neurology at Xuanwu Hospital, Capital Medical University in Beijing, and colleagues wrote. “Tirofiban is commonly used to prevent early reocclusion after [endovascular therapy]. However, whether tirofiban is safe and effective in these patients treated with [endovascular therapy] is unclear.”
To evaluate the safety and efficacy of low-dose tirofiban in patients with acute ischemic stroke treated with endovascular thrombectomy, and its effects on reocclusion prevention and functional outcome improvement, Zhao and colleagues conducted an observational study, based on a single-center prospective registry study.
The researchers enrolled patients with acute ischemic stroke undergoing endovascular thrombectomy with second-generation stent retrievers. Between 2013 and February 2017, these patients received treatment with endovascular thrombectomy alone or endovascular thrombectomy plus low-dose tirofiban.
The primary outcome was symptomatic intracerebral hemorrhage (sICH) and the secondary outcomes included rate of early reocclusion, any ICH, fatal ICH, and 3-month and long-term functional outcomes.
The analysis included 180 patients with acute ischemic stroke, including 90 patients who were treated with tirofiban.
The researchers reported that 35% of patients had ICH, of which 11% were symptomatic and 5% were fatal.
There was no significant difference in sICH between patients treated with tirofiban (11%) and those who were not (10%).
The researchers found that 4.4% of patients treated with tirofiban experienced early reocclusion vs. 8.9% of patients who were not treated with tirofiban (P = .37).
According to data from the 89% of patients who completed long-term follow-up, tirofiban treatment was associated with lower mortality risk compared with no tirofiban (23% vs. 44; P = .005).
The results also showed that tirofiban was linked to improved likelihood of long-term functional independence (adjusted OR = 4.37; 95% CI, 1.13-16.97).
“In [acute ischemic stroke] patients treated with [endovascular thrombectomy], a low dose of tirofiban is neither associated with an increase for any ICH, sICH and fatal ICH nor associated with 3-month and long-term mortality,” the researchers wrote. “Further studies are needed to fine-tune the optimal treatment protocol that can lead to better efficacy in preventing early reocclusion and improving outcomes.”– by Dave Quaile
Disclosure: The authors report no relevant financial disclosures.
Editor’s note: This article was updated on Jan. 2, 2018, to correctly reference tirofiban. The editors regret the error.
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