Safety And Efficacy Of Tirofiban In Acute Ischemic Stroke Patients

Part 1 Safety and Preliminary Efficacy of Early Tirofiban Treatment After Alteplase in Acute Ischemic Stroke PatientsObjective:In this study,we tried to demonstrate if the early antiplatelet therapy by tirofiban,a glycoprotein IIb/IIIa antagonist,can safely reduce the risk of re-occlusion and improve outcome in acute ischemic stroke patients(AIS)after alteplase(rt-PA).Methods:Forty-one patients were enrolled and received rt-PA followed with intravenous tirofiban infusion for at least 24 hours.Safety outcomes were assessed by the incidence of symptomatic intracranial hemorrhage(s ICH),systematic bleedings and death due to all causes.Efficacy outcomes were evaluated with National Institutes of Health Stroke Scale(NIHSS)score at 24 hours and day 7 or hospital discharge.Modified Rankin scale(m RS)was assessed at 3 months.Outcomes for these patients were compared with a propensity-score matched historical cohort with rt-PA only from the same stroke center.Results:There was no significant difference in the baseline(including gender,age,the history of hypertension,diabetes mellitus,coronary heart disease,atrial fibrillation,transient ischemic attack or etc.)between two groups(P>0.05).The risk of s ICH,death or systematic bleeding(p = 1.00)was not increased in the rt-PA/tirofiban group.Fewer patients suffered re-occlusion in rt-PA/tirofiban group(2.4% vs.22%;P=0.025;OR:0.09;95%CI 0.01-0.74)at 24 h.At hospital day 7 or discharge,the NIHSS score was significantly lower in the rt-PA/tirofiban group(median score: 1 vs.6,p =0.002).At 3 months,more patients in rt-PA/tirofiban group had favorable outcomes(i.e.m RS 0-1)compared with the standard therapy group(70.7% vs.46.2%;p = 0.026).Conclusion:Intravenous tirofiban infusion immediately after rt-PA appears to be safe and potentially more effective when compared with rt-PA alone for AIS patients.Part 2 Safety and Preliminary Efficacy of Intravenous Tirofiban in Ischemic Stroke Patient without Visible Arterial Occlusion and Missed the Best Time for Thrombolysis.Objective:Thrombolysis with rt-PA within 4.5 hours is the priority strategy for acute ischemic stroke patients.However,there is no effective method for the patients who presented exceeding the time frame.In this study,we aim to investigate whether intravenous antiplatelet agent tirofiban is safe and effective in AIS patients without visible arterial occlusion(VAO)and missed the best time for thrombolysis.Method:Total 25 patients received intravenous tirofiban therapy.The safety outcomes were assessed by the incidence of s ICH,systematic bleeding and mortality.Efficacy outcomes were evaluated with NIHSS score improvement at 24 hours and day 7(or discharge)and modified Rankin Scale(m RS)at 90 days.Outcomes for these patients were compared with a historical matched cohort treated with aspirin(ASA)and/or clopidogrel(CLP).Results:There was no significant difference in the baseline(including gender,age,the history of Hypertension,Diabetes mellitus,coronary heart disease,atrial fibrillation,transient ischemic attack or etc.)between two groups.The incidence of intracerebral hemorrhage,severe systematic bleedings and death were not found in both groups.At day 7 or discharge,the neurological function improved significantly in both treatment groups.However,the NIHSS score was lower in tirofiban group compared with the control group(P = 0.045).At 3 months,more patients in tirofiban group had favorable outcomes(m RS 0-1)compared with control group(84% vs.52%;P = 0.021;odds ratio:12.80;95% CI: 1.48-111.10).Conclusions:Intravenous tirofiban seems to be safe and potentially more effective for the ischemic stroke patients without visible artery occlusion who didn't receive thrombolytic therapy in time.