Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis
BackgroundIntravenous thrombolysis (IVT) is a standard procedure for the treatment of patients with acute ischemic stroke (AIS). Improving the therapeutic efficacy of IVT is an important task for neurologists. The aim of this study was to evaluate the efficacy and safety of early low-dose tirofiban...
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.982684/full |
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| author | Yan Zhang Jianliang Wang Zhaoxi Ma Guihua Mu Da Liang Yifan Li Xiaoyan Qian Luyuan Zhang Fang Shen Lei Zhang Jie Yu Yang Liu |
| author_facet | Yan Zhang Jianliang Wang Zhaoxi Ma Guihua Mu Da Liang Yifan Li Xiaoyan Qian Luyuan Zhang Fang Shen Lei Zhang Jie Yu Yang Liu |
| author_sort | Yan Zhang |
| collection | DOAJ |
| description | BackgroundIntravenous thrombolysis (IVT) is a standard procedure for the treatment of patients with acute ischemic stroke (AIS). Improving the therapeutic efficacy of IVT is an important task for neurologists. The aim of this study was to evaluate the efficacy and safety of early low-dose tirofiban treatment in AIS patients with early neurological deterioration (END) after IVT.MethodsIn this prospective and randomized pilot study, 73 AIS patients with END were recruited from a local hospital in China. Of these, 14 patients were treated with regular antiplatelet agents (aspirin plus clopidogrel) and 59 patients were treated with tirofiban within 24 h of IVT, followed by regular antiplatelet therapy. Neurological deficits and functional recovery were assessed with NIHSS and modified Rankin Scale (mRS) at 7 and 90 days. During the 90-day follow-up period, both hemorrhagic (e.g., intracerebral hemorrhage) and non-hemorrhagic (e.g., pneumonia) events were recorded.ResultsTreatment with tirofiban compared with regular antiplatelet therapy: (1) improved functional recovery of AIS patients to mRS (≤2) at both 7 and 90 days (odds ratios [ORs], 1.37 and 1.64; 95% confidence interval [CI], 1.16–1.61 and 1.26–2.12; P = 0.008 and < 0.001, respectively), and (2) reduced NIHSS scores from 11.14 ± 2.38 to 5.95 ± 3.48 at day 7 (P < 0.001) and from 8.14 ± 2.74 to 4.08 ± 3.50 at day 90 (P < 0.001). Tirofiban treatment did not increase the risk of hemorrhagic complications. Multivariate regression analysis showed that tirofiban treatment independently predicted a favorable functional outcome (P ≤ 0.001).ConclusionEarly treatment with low-dose tirofiban in AIS patients with neurologic deterioration after IVT potentially improved functional recovery and attenuated neurologic deficits as early as 7 days and did not increase the risk of various hemorrhagic complications. However, the therapeutic efficacy of tirofiban treatment in END patients needs to be determined by future randomized clinical trials with a large study population.Clinical trial registrationhttp://www.chictr.org.cn/, Identifier ChiCTR2200058513. |
| first_indexed | 2024-04-11T09:20:28Z |
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| id | doaj.art-768c2c749a9c4377891e8b05d0fc947a |
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| language | English |
| last_indexed | 2024-04-11T09:20:28Z |
| publishDate | 2022-10-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-768c2c749a9c4377891e8b05d0fc947a2022-12-22T04:32:13ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-10-011310.3389/fneur.2022.982684982684Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysisYan Zhang0Jianliang Wang1Zhaoxi Ma2Guihua Mu3Da Liang4Yifan Li5Xiaoyan Qian6Luyuan Zhang7Fang Shen8Lei Zhang9Jie Yu10Yang Liu11Department of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, ChinaDepartment of Radiology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, ChinaDepartment of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, ChinaDepartment of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, ChinaDepartment of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, ChinaDepartment of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, ChinaDepartment of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, ChinaDepartment of Scientific and Technological Talents, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, ChinaDepartment of Outpatient, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, ChinaDepartment of Neurology, The Kunshan Affiliated Hospital of Jiangsu University, The First People's Hospital of Kunshan, Kunshan, ChinaDepartment of Neurology, The Second People's Hospital of Kunshan, Kunshan, ChinaDepartment of Neurology, Saarland University, Homburg, GermanyBackgroundIntravenous thrombolysis (IVT) is a standard procedure for the treatment of patients with acute ischemic stroke (AIS). Improving the therapeutic efficacy of IVT is an important task for neurologists. The aim of this study was to evaluate the efficacy and safety of early low-dose tirofiban treatment in AIS patients with early neurological deterioration (END) after IVT.MethodsIn this prospective and randomized pilot study, 73 AIS patients with END were recruited from a local hospital in China. Of these, 14 patients were treated with regular antiplatelet agents (aspirin plus clopidogrel) and 59 patients were treated with tirofiban within 24 h of IVT, followed by regular antiplatelet therapy. Neurological deficits and functional recovery were assessed with NIHSS and modified Rankin Scale (mRS) at 7 and 90 days. During the 90-day follow-up period, both hemorrhagic (e.g., intracerebral hemorrhage) and non-hemorrhagic (e.g., pneumonia) events were recorded.ResultsTreatment with tirofiban compared with regular antiplatelet therapy: (1) improved functional recovery of AIS patients to mRS (≤2) at both 7 and 90 days (odds ratios [ORs], 1.37 and 1.64; 95% confidence interval [CI], 1.16–1.61 and 1.26–2.12; P = 0.008 and < 0.001, respectively), and (2) reduced NIHSS scores from 11.14 ± 2.38 to 5.95 ± 3.48 at day 7 (P < 0.001) and from 8.14 ± 2.74 to 4.08 ± 3.50 at day 90 (P < 0.001). Tirofiban treatment did not increase the risk of hemorrhagic complications. Multivariate regression analysis showed that tirofiban treatment independently predicted a favorable functional outcome (P ≤ 0.001).ConclusionEarly treatment with low-dose tirofiban in AIS patients with neurologic deterioration after IVT potentially improved functional recovery and attenuated neurologic deficits as early as 7 days and did not increase the risk of various hemorrhagic complications. However, the therapeutic efficacy of tirofiban treatment in END patients needs to be determined by future randomized clinical trials with a large study population.Clinical trial registrationhttp://www.chictr.org.cn/, Identifier ChiCTR2200058513.https://www.frontiersin.org/articles/10.3389/fneur.2022.982684/fullcerebrovascular diseasestrokethrombolytic therapyantiplatelet therapytirofiban |
| spellingShingle | Yan Zhang Jianliang Wang Zhaoxi Ma Guihua Mu Da Liang Yifan Li Xiaoyan Qian Luyuan Zhang Fang Shen Lei Zhang Jie Yu Yang Liu Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis Frontiers in Neurology cerebrovascular disease stroke thrombolytic therapy antiplatelet therapy tirofiban |
| title | Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis |
| title_full | Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis |
| title_fullStr | Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis |
| title_full_unstemmed | Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis |
| title_short | Prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis |
| title_sort | prospective pilot study of tirofiban in progressive stroke after intravenous thrombolysis |
| topic | cerebrovascular disease stroke thrombolytic therapy antiplatelet therapy tirofiban |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.982684/full |
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