Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function
Abstract Objective Renal function can modify the outcomes of large vessel occlusion (LVO) stroke across stroke etiologies in disparate degrees. The presence of renal function deficit can also impair the pharmacokinetics of tirofiban. Hence, this study aimed to investigate the roles of renal function...
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | Annals of Clinical and Translational Neurology |
| Online Access: | https://doi.org/10.1002/acn3.51982 |
| _version_ | 1797245010864766976 |
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| author | Chang Liu Fengli Li Liyuan Chen Jiacheng Huang Hongfei Sang Thanh N. Nguyen Jeffrey L. Saver Mohamad Abdalkader Weiling Kong Jie Yang Changwei Guo Chen Gong Liping Huang Yanzhu Pan Xinxin Wang Yangmei Chen Zhongming Qiu Wenjie Zi |
| author_facet | Chang Liu Fengli Li Liyuan Chen Jiacheng Huang Hongfei Sang Thanh N. Nguyen Jeffrey L. Saver Mohamad Abdalkader Weiling Kong Jie Yang Changwei Guo Chen Gong Liping Huang Yanzhu Pan Xinxin Wang Yangmei Chen Zhongming Qiu Wenjie Zi |
| author_sort | Chang Liu |
| collection | DOAJ |
| description | Abstract Objective Renal function can modify the outcomes of large vessel occlusion (LVO) stroke across stroke etiologies in disparate degrees. The presence of renal function deficit can also impair the pharmacokinetics of tirofiban. Hence, this study aimed to investigate the roles of renal function in determining efficacy and safety of intravenous tirofiban before endovascular treatment (EVT) for acute ischemic stroke patients with large vessel occlusion (LVO). Methods This study was a post hoc exploratory analysis of the RESCUE‐BT trial. The primary outcome was the proportion of patients achieving functional independence (modified Rankin scale 0–2) at 90 days, and the primary safety outcome was the rate of symptomatic intracranial hemorrhage (sICH). Results Among 908 individuals with available serum creatinine, decreased estimated glomerular filtration rate (eGFR) status was noted more commonly in patients with cardioembolic stroke (CE), while large artery atherosclerosis (LAA) was predominant in patients with normal renal function. In LAA with normal renal function, tirofiban was associated with higher rates of functional independence at 90 days (41.67% vs 59.80%, p = 0.003). However, for LVO patients with renal dysfunction, tirofiban did not improve functional outcomes for any of the etiologies (LAA, p = 0.876; CE, p = 0.662; others, p = 0.894) and significantly increased the risk of sICH among non‐LAA patients (p = 0.020). Mediation analysis showed tirofiban reduced thrombectomy passes (12.27%) and drug/placebo to recanalization time (14.25%) mediated its effects on functional independence. Conclusion This present study demonstrated the importance of evaluating renal function before administering intravenous tirofiban among patients with LVO who are planned to undergo EVT. |
| first_indexed | 2024-04-24T19:20:07Z |
| format | Article |
| id | doaj.art-d1624430e875435db9d42c4b899392c1 |
| institution | Directory Open Access Journal |
| issn | 2328-9503 |
| language | English |
| last_indexed | 2024-04-24T19:20:07Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Clinical and Translational Neurology |
| spelling | doaj.art-d1624430e875435db9d42c4b899392c12024-03-26T03:13:57ZengWileyAnnals of Clinical and Translational Neurology2328-95032024-03-0111361862810.1002/acn3.51982Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal functionChang Liu0Fengli Li1Liyuan Chen2Jiacheng Huang3Hongfei Sang4Thanh N. Nguyen5Jeffrey L. Saver6Mohamad Abdalkader7Weiling Kong8Jie Yang9Changwei Guo10Chen Gong11Liping Huang12Yanzhu Pan13Xinxin Wang14Yangmei Chen15Zhongming Qiu16Wenjie Zi17Department of Neurology The Second Affiliated Hospital, Chongqing Medical University Chongqing ChinaDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital Army Medical University (Third Military Medical University) Chongqing ChinaDepartment of Neurology The Second Affiliated Hospital, Chongqing Medical University Chongqing ChinaDepartment of Neurology The Second Affiliated Hospital, Chongqing Medical University Chongqing ChinaNeurology, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine Hangzhou ChinaDepartment of Neurology, Boston Medical Center Boston University Chobanian and Avedisian School of Medicine Boston Massachusetts USANeurology University of California in Los Angeles Los Angeles California USADepartment of Radiology, Boston Medical Center Boston University Chobanian and Avedisian School of Medicine Boston Massachusetts USADepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital Army Medical University (Third Military Medical University) Chongqing ChinaDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital Army Medical University (Third Military Medical University) Chongqing ChinaDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital Army Medical University (Third Military Medical University) Chongqing ChinaDepartment of Neurology The Second Affiliated Hospital, Chongqing Medical University Chongqing ChinaDepartment of Neurology The Second Affiliated Hospital, Chongqing Medical University Chongqing ChinaDepartment of Neurology The Second Affiliated Hospital, Chongqing Medical University Chongqing ChinaDepartment of Neurology The Second Affiliated Hospital, Chongqing Medical University Chongqing ChinaDepartment of Neurology The Second Affiliated Hospital, Chongqing Medical University Chongqing ChinaDepartment of Neurology, The 903rd Hospital of The Chinese People's Liberation Army Hangzhou ChinaDepartment of Neurology, Xinqiao Hospital and The Second Affiliated Hospital Army Medical University (Third Military Medical University) Chongqing ChinaAbstract Objective Renal function can modify the outcomes of large vessel occlusion (LVO) stroke across stroke etiologies in disparate degrees. The presence of renal function deficit can also impair the pharmacokinetics of tirofiban. Hence, this study aimed to investigate the roles of renal function in determining efficacy and safety of intravenous tirofiban before endovascular treatment (EVT) for acute ischemic stroke patients with large vessel occlusion (LVO). Methods This study was a post hoc exploratory analysis of the RESCUE‐BT trial. The primary outcome was the proportion of patients achieving functional independence (modified Rankin scale 0–2) at 90 days, and the primary safety outcome was the rate of symptomatic intracranial hemorrhage (sICH). Results Among 908 individuals with available serum creatinine, decreased estimated glomerular filtration rate (eGFR) status was noted more commonly in patients with cardioembolic stroke (CE), while large artery atherosclerosis (LAA) was predominant in patients with normal renal function. In LAA with normal renal function, tirofiban was associated with higher rates of functional independence at 90 days (41.67% vs 59.80%, p = 0.003). However, for LVO patients with renal dysfunction, tirofiban did not improve functional outcomes for any of the etiologies (LAA, p = 0.876; CE, p = 0.662; others, p = 0.894) and significantly increased the risk of sICH among non‐LAA patients (p = 0.020). Mediation analysis showed tirofiban reduced thrombectomy passes (12.27%) and drug/placebo to recanalization time (14.25%) mediated its effects on functional independence. Conclusion This present study demonstrated the importance of evaluating renal function before administering intravenous tirofiban among patients with LVO who are planned to undergo EVT.https://doi.org/10.1002/acn3.51982 |
| spellingShingle | Chang Liu Fengli Li Liyuan Chen Jiacheng Huang Hongfei Sang Thanh N. Nguyen Jeffrey L. Saver Mohamad Abdalkader Weiling Kong Jie Yang Changwei Guo Chen Gong Liping Huang Yanzhu Pan Xinxin Wang Yangmei Chen Zhongming Qiu Wenjie Zi Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function Annals of Clinical and Translational Neurology |
| title | Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function |
| title_full | Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function |
| title_fullStr | Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function |
| title_full_unstemmed | Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function |
| title_short | Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function |
| title_sort | effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function |
| url | https://doi.org/10.1002/acn3.51982 |
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