Efficacy And Safety Evaluation Of Tirofiban In The Treatment Of Acute Ischemic Stroke

Objective:To explore the efficacy and safety of tirofiban combined with oral antiplatelet therapy compared with conventional oral antiplatelet therapy in patients with non-thrombolytic,non-thrombectomy and non-cardiogenicacute ischemic stroke within 48 hours of onset.Methods:This is a prospective study based on the real world,one hundred and seventeen patients with non-thrombolytic,non-thrombolysis and non-cardiogenic acute cerebral infarction within 48 hours of onset in the Department of Neurology from January 2021 to June 2022 were prospectively collected,and the enrolled patients were assigned to Tirofiban group or oral antiplatelet drug group according to their treatment intentions.The tirofiban group was injected intravenously after admission,pumped intravenously at a rate of 0.4ug/kg/min for the first30 min,then maintained pumped at a rate of 0.1ug/kg/min for at least 24 h,and then treated with aspirin and/or clopidogrel(overlap 4 hours).In the oral antiplatelet treatment group,aspirin and/or clopidogrel were taken orally directly after admission.Neurological impairment score(NIHSS score),functional disability score(m RS Score),bleeding rate within 48 hours of drug treatment(intracranial bleeding rate,gastrointestinal bleeding rate and skin and oral mucosa bleeding rate)and mortality at 6 months after onset were compared.General data,laboratory indicators,NIHSS scores before treatment and 1,3 and 7 days after treatment,m RS Scores before treatment and 1,3 and 6 months after treatment and other indicators were collected,adverse events and death events were recorded,and relevant data were analyzed.NIHSS score and m RS Score were used to evaluate the efficacy,and bleeding rate and mortality were used to evaluatethe safety ofmedication.Results:1.Comparison the baseline data of two groups: There were no significant differences in height,weight,age,sex,history of hypertension,diabetes,coronary heart disease,smoking,drinking,history of ischemic stroke,history of hemorrhagic stroke,history of TIA,history of hyperhomocysteinemia,history of hyperlipidemia,admission systolic and diastolic blood pressure,and laboratory indexes(P > 0.05).The two groups of patients were comparable.2.The 7d NIHSS score of the Tirofiban group after treatment was lower than that of the oral antiplatelet group,and there were significant difference in two group(P=0.018),that is,the neurological impairment of the Tirofiban group was less than that of the oral antiplatelet group.The 6-month m RS Score of the Tirofiban group was significantly lower than the oral antiplatelet group,and the difference was significant(P=0.028),indicating that the daily life quality of the Tirofiban group was better than the oral antiplatelet group.3.Within 48 hours of medication,there were 2(3.4%)cases of oral mucosal bleeding and 2(3.4%)cases of digestive tractbleeding in the Tirofiban group,2(3.4%)cases of oral mucosal bleeding and 1(1.6%)case of digestive tract bleeding in the control group,and no intracranial bleeding occurred in the two groups.Between two groups,There was no significant difference in bleeding events(P=0.981).There were 2(3.8%)deaths in the Tirofiban group and 4(7.7%)deaths in the oral antiplatelet druggroup.Among two groups,there was no statistically significant difference(P=0.657).Conclusion:1.For patients with non-thrombectomy,non-thrombolytic and non-cardiogenic ischemic stroke within 48 hours of onset,Tirofiban combined with oral antiplatelet drugs has a better effect than oral antiplatelet drugs alone,and the symptoms of neurological impairment are improved more significantly,which can improve the quality of daily life.2.For patients with non-thrombolysis,non-thrombolytic and non-cardiogenic ischemic stroke within 48 hours of onset,there was no significant difference in adverse bleeding reactions and death between Tirofiban and oral antiplatelet drugs alone,and the incidence was low,indicating that the drug was safe and reliable.3.The efficacy of Tirofiban combined with oral antiplatelet therapy for acute ischemic stroke patients within 24 hours of onset is superior to oral antiplatelet therapy alone,with no significant difference in safety.4.Tirofiban administration within 24-48 hours of onset showed no significant difference in efficacy compared with oral antiplatelet therapy alone,but did not increase the risk of bleeding events and death events.4.For patients with non-thrombolysis,non-thrombolytic and non-cardiogenic ischemic stroke within 48 hours of onset,the efficacy of tirofiban treatment in patients with small artery occlusion is better than that in the large atherosclerosis group,and the occurrence of adverse bleeding events and death events is not increased.