Safety And Efficacy Of Tirofiban In The Treatment Of Mild To Moderate Acute Non-cardiogenic Ischemic Stroke Screened By MRI

Objective: Mild to moderate non-cardiogenic ischemic stroke is volatile in the acute phase and tends to progress to worsen,leading to severe neurological deficits.The antithrombotic treatment strategy of such patients in the acute stage has always been a research hotspot,and the accurate antithrombotic strategy based on image screening has not been reported at present,which is of great significance.This study aim to explore the safety and clinical efficacy of intravenous tirofiban in the treatment of mild to moderate non-cardiac ischemic stroke screened by MRI in the acute phase,and to seek the optimal treatment plan for non-cardiac ischemic stroke in the acute phase.Methods: 74 patients with non-cardiogenic ischemic stroke who were hospitalized in the Department of Neurology,the Fourth Affiliated Clinical Medical College of Qingdao University from January 2020 to June 2021 and underwent MRI examination within 6-72 hours after onset were selected as the study subjects.Brain MRI showed that the core infarct area on the DWI sequence were smaller than 1/3 of the medial cerebral arteria(MCA)or posterior cerebral artery(PCA)dominated area,MRA excludes large vessel occlusion.All patients were randomly divided into the experimental group and control group by a method of the table of random digit according to a ratio of 1:1.The experimental group(n=37)was treated with intravenous infusion of tirofiban for 72 hours(0.4 μg·kg-1·min-1 for 30 minutes,and 0.1 μg·kg-1·min-1 for 72 hours),and ended taking loading doses of clopidogrel(300 mg)and aspirin(100 mg)4 hours earlier,followed by aspirin(100 mg,once a day)and clopidogrel(75 mg,once a day)to the 21 th day.Then single aspirin(100 mg,once a day)or clopidogrel(75 mg,once a day)was used for 69 days.The control group(n=37)was not treated with tirofiban,and the antiplatelet therapy strategy was the same as the experimental group.Other treatments include standard secondary stroke prevention treatment such as oral statins.To evaluate the safety and clinical efficacy of tirofiban in these patients.Collect demographic information and routine laboratory tests of patients,the main observation indicators were safety,recording of bleeding events that occurred during hospitalization or within 14 days,including symptomatic intracranial hemorrhage(s ICH)within 72 hours,conversion of intracranial hemorrhage and hemorrhage in other parts during hospitalization or within 14 days,while recording allcause deaths within 90 days.The secondary observation index is curative efficacy,We follow up National Institutes of Health Stroke Scale(NIHSS)scores at 72-hour,14-day to evaluate the improvement of neurological deficit symptoms.During hospitalization or within 14 days,the deterioration of neurological function were recorded.On the 90 th day,to assess 90-day clinical prognosis of all enrolled patients by modified Rankin Scales (m RS),the criterion for a favorable prognosis was defined as m RS score of 0 to 2.SPSS 22.0 software was used to perform statistical analysis of the results.Results: After the enrollment process,1 patient in the control group was excluded who did not follow the study method,and a total of 73 patients were finally analyzed in this study who were completed the follow-up with complete data,there were 37 patients in the experimental group and 36 patients in the control group.The general characteristics between the two group patients had no statistically significant differences.In terms of safety,three patients in the experimental group had bleeding from other sites during hospitalization or within 14 days,and no patients in the control group,and there was no statistically significant difference in bleeding rates in other areas between the two groups(8.1% vs 0,P=0.250).The incidence of s ICH within 72 hours,intracranial hemorrhage during hospitalization or within 14 days,and all-cause mortality within 90 days was zero in both groups.In terms of efficacy,three patients in the experimental group had neurological deterioration events,and ten patients in the control group,compared with the two groups,the rate of neurological deterioration was statistically significant(8.1% vs 27.8%,P=0.028).In addition,the NIHSS scores were lower in the experimental group than in the control group at 72 hours [5.00(4.00-6.50)vs 6.00(5.00-8.00),P=0.034] and 14 days [3.00(2.00-5.00)vs 4.50(3.00-6.00),P=0.022],after 14 days of treatment,the symptoms of neurological deficit in both groups were improved compared with those before treatment,the experimental group is more obvious,P<0.001.At 90 days,78.4% of patients in the experimental group had favorable functional outcomes compared with 58.3% of patients with favorable functional outcomes in the control group,there were no statistical differences,P=0.065.Conclusions: For patients with mild to moderate non-cardiogenic ischemic stroke who performed imaging tests,and without aortic occlusion,exceeding the thrombolytic time window,it is safe to treat intravenous tirofiban for 72 hours in the acute phase combined with oral antiplatelet drugs clopidogrel and aspirin.After imaging evaluation,intravenous application of tirofiban for 72 hours with dual antiplatelet aggregation therapy can reduce the occurrence of early neurological deterioration events,improve the symptoms of neurological deficits in patients,which may be an effective treatment in the acute stage for patients with mild to moderate non-cardiogenic ischemic stroke and without aortic occlusion.