Efficacy Of Tirofiban Sequential Aspirin In The Treatment Of Acute And Moderate Ischemic Stroke

Background:The incidence rate of acute ischemic stroke（AIS）has been increasing year by year in recent years.Ultra early treatment（intravenous thrombolysis and intravascular intervention）has become a research hotspot of researchers.Due to the limitations of intravenous thrombolysis and intravascular treatment,the early treatment of AIS has been in a stalemate.Considering that a large number of studies have proved the safety and effectiveness of tirofiban in acutecoronarysyndrome（ACS）,the application of tirofiban in ACS has been extended to the treatment of AIS.Most of them are about the progressive stroke after vascular intervention and thrombolysis,and have been added to the 2015 guidelines for early intravascular intervention in the diagnosis and treatment of acute ischemic stroke in China.There are few studies on the safety and effectiveness of tirofiban sequential aspirin in the treatment of AIS,and the safety conclusions are basically the same.No clear conclusion is given on whether tirofiban can improve the neurological outcome.Most scholars believe that tirofiban can improve the neurological outcome,while few mathematicians have put forward different views.This study compared the changes of NIHSS score and mRS score between tirofiban group and aspirin group before and after treatment,so as to evaluate the efficacy of tirofiban sequential aspirin in the treatment of acute and moderate ischemic stroke.Objective:The purpose of this study was to evaluate whether tirofiban sequential aspirin is safe and can better improve the neurological prognosis of patients with acute and moderate ischemic stroke compared with traditional aspirin.Methods:60 patients with AIS diagnosed in the inpatient department of the cardiovascular and cerebrovascular branch of the Affiliated Hospital of Yan’an University from November 2020 to November 2021 were collected.According to the Napai standard,the eligible patients were randomly assigned to tirofiban（30 cases）and aspirin group（30 cases）.One patient in the experimental group found large vessel stenosis after tirofiban treatment,transferred to neurosurgery for further treatment,and was excluded from the experimental group,Therefore,29 cases were finally included in tirofi group.NIHSS score and mRS score were used to evaluate the prognosis of neurological function,and to observe whether the patients had adverse complications such as intracranial hemorrhage（symptomatic and asymptomatic）,severe or fatal systemic hemorrhage,death within 3 months and thrombocytopenia.Results:1.Baseline data:59 AIS patients were included,including 29 in the experimental group and 30 in the control group.There was no significant difference between the two groups（p>0.05）,which can be considered as comparable between the two groups.See table 2-1-1 and table 2-1-2.2.Intra group comparison in the experimental group:the NIHSS score and Mrs score of tirofiban before treatment,7 days after treatment and 3 months after treatment were compared.As shown in table 2-2-1,table 2-2-2 and table 2-2-3,χ2n=58,pn<0.001,χ2m=57,pm<0.001.The NIHSS score and mRS score of the experimental group before and after treatment were significantly different.It can be seen that tirofiban sequential aspirin can improve the NIHSS score and mRS score of patients 7 days and 3 months after treatment.3.Comparison within the control group:the NIHSS score and mRS score of the aspirin group before treatment,7 days and 3 months after treatment are compared as shown in table 2-3-1,table 2-3-2 and table 2-3-3.It can be seen that pn<0.001,pm<0.001.The difference between the NIHSS score and mRS score of the aspirin group before and after treatment is statistically significant,suggesting that aspirin can improve the NIHSS score and mRS score of the patients 7 days and 3 months after treatment.4.Comparison of NIHSS score and mRS score 7 days after treatment between the two groups:comparison of NIHSS score and mRS score 7 days after treatment between tirofiban group and aspirin group,p<0.05,indicating that the difference between NIHSS score and mRS score 7 days after treatment between the two groups is statistically significant,suggesting that tirofiban sequential aspirin can better improve NIHSS score and mRS score 7 days after treatment than aspirin.See table 2-4-1 and table 2-4-2.5.Comparison of NIHSS score and mRS score of the two groups 3 months after treatment:the comparison of NIHSS score and mRS score of tirofiban and aspirin group 3 months after treatment,p<0.05,indicates that the difference between NIHSS score and mRS score of the two groups 3 months after intervention is statistically significant,suggesting that tirofiban can better improve the neurological prognosis of patients,see table 2-5-2 and table 2-5-2.6.Adverse reactions and complications:no ICH（symptomatic and asymptomatic）,severe or fatal systemic bleeding and death within 3 months were found in both groups.Although the platelet count of 3 and 5 patients in the experimental group and the control group decreased slightly,the difference between the two groups was small and negligible,as shown in table 2-6-1.Conclusion:1.Tirofiban sequential aspirin can improve the prognosis of neurological function and reduce neurological disability in patients with acute and moderate ischemic stroke.2.Tirofiban sequential aspirin is safe in the treatment of acute moderate ischemic stroke.