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Rodrigo-Gisbert M, Hoferica M, García-Tornel A, Requena M, Rubiera M, Lascuevas MDD, Olivé-Gadea M, Diana F, Rizzo F, Muchada M, Carmona T, Rodriguez-Villatoro N, Rodríguez-Luna D, Juega J, Pagola J, Hernández D, Molina CA, Tomasello A, Cognard C, Ribó M. Stent Retriever AssIsted Lysis Technique with Tirofiban: A Potential Bailout Alternative to Angioplasty and Stenting. AJNR Am J Neuroradiol 2024:ajnr.A8374. [PMID: 38849135 DOI: 10.3174/ajnr.a8374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND AND PURPOSE Angioplasty and stent placement have been described as a bailout technique in individuals with failed thrombectomy. We aimed to investigate Stent retriever AssIsted Lysis (SAIL) with tirofiban before angioplasty and stent placement. MATERIALS AND METHODS Patients from 2 comprehensive stroke centers were reviewed (2020-2023). We included patients with failed thrombectomy and/or underlying intracranial stenosis who received SAIL with tirofiban before the intended angioplasty and stent placement. SAIL consisted of deploying a stent retriever through the occluding lesion to create a bypass channel and infuse 10 mL of tirofiban for 10 minutes either intra-arterially or IV. The stent retriever was re-sheathed before retrieval. The primary end points were successful reperfusion (expanded TICI 2b-3) and symptomatic intracerebral hemorrhage. Additional end points included 90-day mRS 0-2 and mortality. RESULTS After a median of 3 (interquartile range, 2-4) passes, 44 patients received the SAIL bridging protocol with tirofiban, and later they were considered potential candidates for angioplasty and stent placement bailout (43.2%, intra-arterial SAIL). Post-SAIL successful reperfusion was obtained in 79.5%. A notable residual stenosis (>50%) after successful SAIL was observed in 45.7%. No significant differences were detected according to post-SAIL: successful reperfusion (intra-arterial SAIL, 80.0% versus IV-SAIL, 78.9%; P = .932), significant stenosis (33.3% versus 55.0%; P = .203), early symptomatic re-occlusion (0% versus 8.0%; P = .207), or symptomatic intracerebral hemorrhage (5.3% versus 8.0%; P = .721). Rescue angioplasty and stent placement were finally performed in 15 (34.1%) patients (intra-arterial SAIL 21.0% versus IV-SAIL 44%; P = .112). At 90 days, mRS 0-2 (intra-arterial SAIL 50.0% versus IV-SAIL 43.5%; P = .086) and mortality (26.3% versus 12.0%; P = .223) were also similar. CONCLUSIONS In patients with stroke in which angioplasty and stent placement are considered, SAIL with tirofiban, either intra-arterial or IV, seems to safely induce sustained recanalization, offering a potential alternative to definitive angioplasty and stent placement.
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Affiliation(s)
- Marc Rodrigo-Gisbert
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matúš Hoferica
- Department of Diagnostic Neuroradiology (M.H., C.C.), Hôpital Purpan, Centre Hospitalier Universitaire, Toulouse, France
| | - Alvaro García-Tornel
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Requena
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marta Rubiera
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta De Dios Lascuevas
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marta Olivé-Gadea
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesco Diana
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Federica Rizzo
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marian Muchada
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomás Carmona
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Noelia Rodriguez-Villatoro
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Rodríguez-Luna
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesus Juega
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jorge Pagola
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - David Hernández
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Carlos A Molina
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Alejandro Tomasello
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Neuroradiology (M. Requena, M.D.D.L., F.D., T.C., D.H., A.T.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Christophe Cognard
- Department of Diagnostic Neuroradiology (M.H., C.C.), Hôpital Purpan, Centre Hospitalier Universitaire, Toulouse, France
| | - Marc Ribó
- From the Stroke Unit, Department of Neurology (M.R.-G., A.G.-T., M. Requena, M. Rubiera, M.O.-G., F.R., M.M., N.R.-V., D.R.-L., J.J., J.P., C.A.M., M.R.), Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Department de Medicina (M.R.-G, A.G.-T., M. Requena, M. Rubiera, M.D.D.L., M.O.-G., F.D., F.R., M.M., T.C., N.R.-V., D.R.-L., J.J., J.P., D.H., C.A.M., A.T., M.R.), Universitat Autònoma de Barcelona, Barcelona, Spain
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Li W, Wang K, Zeng C, Huang K, Fu Y, Zhao Z. Safety and efficacy of tirofiban treatment in the endovascular treatment of patients with acute ischaemic stroke - A meta-analysis. Clin Neurol Neurosurg 2024; 243:108330. [PMID: 38936178 DOI: 10.1016/j.clineuro.2024.108330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/22/2024] [Accepted: 05/11/2024] [Indexed: 06/29/2024]
Abstract
OBJECT The use of endovascular therapy (EVT) has become a widespread strategy for the clinical management of acute ischemic stroke (AIS). However, the combination of arterial injection of tirofiban with EVT for AIS continues to be a subject of controversy. This meta-analysis was conducted to assess the safety and efficacy of this treatment approach. METHODS Relevant studies were identified through a systematic literature search in Pubmed, EMBASE, Web of Science, and Cochrane Library databases, covering articles published from January 2010 to January 2023. The efficacy outcomes included favorable functional outcomes, recanalization rates, and safety outcomes including mortality and symptomatic intracranial hemorrhage (sICH). RESULTS The meta-analysis consisted of data from 13 studies, which included 1 randomized controlled trial (RCT), 7 prospective cohort studies, and 5 retrospective cohort studies, encompassing a total of 3477 patients. The study results indicate that the intra-arterial (IA) tirofiban+EVT for AIS is associated with significant improvements in favorable functional outcomes (OR, 1.21; 95%CI, 1.05-1.40; P = 0.009) and recanalization rate (OR, 1.33; 95%CI, 1.06-1.65; P = 0.01), as well as significant reductions in mortality rates (OR, 0.65; 95%CI, 0.53-0.79; P = 0.0001). Subgroup analysis revealed that administering a maintenance dose of intravenous (IV) tirofiban post-EVT was significantly associated with improved functional outcomes and reduced mortality in patients. In addition, there was no increase in the incidence of sICH (OR, 0.92; 95%CI, 0.71-1.20; P = 0.54). CONCLUSION The administration of Intra-arterial tirofiban combined with EVT is an effective and safe treatment strategy for AIS, and postoperative maintenance doses of intravenous tirofiban may be more effective than IA only.
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Affiliation(s)
- Wei Li
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China
| | - Kangmeng Wang
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China
| | - Chaokun Zeng
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China
| | - KaiLai Huang
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China
| | - YuSi Fu
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China
| | - Zhenqiang Zhao
- Department of Neurology,The First Affiliated Hospital of Hainan Medical University, Hainan province, China.
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Zhang Y, Zhang P, Tao A, Wang X, Ying J, Wang Z, Yang P, Zhang Y, Zhang L, Li Z, Zhang M, Xu C, Liu J. The Efficacy and Safety of Tirofiban Use in Endovascular Thrombectomy for Intravenous Thrombolysis Applicable Patients with Large Vessel Occlusion Stroke-a Post Hoc Analysis from the Direct-MT Trial. Cardiovasc Intervent Radiol 2024; 47:208-215. [PMID: 37798430 PMCID: PMC10844137 DOI: 10.1007/s00270-023-03540-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/13/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the efficacy and safety of tirofiban use in endovascular thrombectomy for intravenous thrombolysis applicable patients of large vessel occlusion stroke with data from Direct-MT trial. MATERIALS AND METHODS Direct-MT was the first randomized controlled trial to prove the non-inferiority of thrombectomy alone to bridging therapy (intravenous thrombolysis before thrombectomy) for large vessel occlusion stroke. Patients who underwent endovascular procedure were included and divided into thrombectomy-alone group and bridging therapy group. The effect of tirofiban use on 90 days MRS distribution, MRS 0-2 and mortality, successful reperfusion, the ASPECTS and outcome lesion volume of index stroke, re-occlusion of the treated vessel, futile recanalization and safety outcomes were further evaluated in both groups after adjustment for relevant confounding factors. The interaction between tirofiban and rt-PA was also assessed. RESULTS Of 639 patients included in this analysis, 180 patients underwent thrombectomy with tirofiban use (28.2%). Patients with tirofiban use had lower percentage of bridging therapy (41.1% vs 54.3%, P = 0.003), higher proportion of large artery atherosclerosis (P < 0.001) and more emergent stenting (30.56% vs 6.97%, P < 0.001). After adjustment for confounding factors, the 90-day modified Rankin Scale distribution, successful final recanalization rate, outcome lesion volume of index stroke on CT and intracranial hemorrhage risk showed no difference after tirofiban use in thrombectomy-alone group and in bridging therapy group. No interaction effect between tirofiban and rt-PA was detected. CONCLUSION Based on data from Direct-MT trial, tirofiban is a safe medication for intravenous thrombolysis applicable patients with large vessel occlusion stroke undergoing thrombectomy. LEVEL OF EVIDENCE Level 3, cohort study of randomized trial.
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Affiliation(s)
- Yingying Zhang
- Department of Neurology, Fudan University Zhongshan Hospital, Shanghai, China
| | - Ping Zhang
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
- Department of Neurology, Naval Medical University Naval Medical Center of PLA, Shanghai, China
| | - Anyang Tao
- Department of Neurology, Taizhou First People's Hospital, 218 Hengjie Road, Taizhou, 318020, Zhejiang, China
| | - Xinliang Wang
- Department of Neurology, Taizhou First People's Hospital, 218 Hengjie Road, Taizhou, 318020, Zhejiang, China
| | - Jiangxian Ying
- Department of Neurology, Taizhou First People's Hospital, 218 Hengjie Road, Taizhou, 318020, Zhejiang, China
| | - Zhimin Wang
- Department of Neurology, Taizhou First People's Hospital, 218 Hengjie Road, Taizhou, 318020, Zhejiang, China
| | - Pengfei Yang
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Yongwei Zhang
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Lei Zhang
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Zifu Li
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Meng Zhang
- Department of Neurosurgery, Liaocheng People's Hospital of Shandong First Medical University, 67 West Dongchang Road, Liaocheng, 252200, Shandong, China.
| | - Chenghua Xu
- Department of Neurology, Taizhou First People's Hospital, 218 Hengjie Road, Taizhou, 318020, Zhejiang, China.
| | - Jianmin Liu
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
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Desai H, Al-Salihi MM, Morsi RZ, Vayani OR, Kothari SA, Thind S, Carrión-Penagos J, Baskaran A, Tarabichi A, Bonderski VA, Siegler JE, Hahn M, Coleman ER, Brorson JR, Mendelson SJ, Mansour A, Dabus G, Hurley M, Prabhakaran S, Linfante I, Kass-Hout T. Intravenous cangrelor use for neuroendovascular procedures: a two-center experience and updated systematic review. Front Neurol 2023; 14:1304599. [PMID: 38116108 PMCID: PMC10728671 DOI: 10.3389/fneur.2023.1304599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/10/2023] [Indexed: 12/21/2023] Open
Abstract
Background The optimal antiplatelet therapy regimen for certain neuroendovascular procedures remains unclear. This study investigates the safety and feasibility of intravenous dose-adjusted cangrelor in patients undergoing acute neuroendovascular interventions. Methods We conducted a retrospective chart review of all consecutive patients on intravenous cangrelor for neuroendovascular procedures between September 1, 2020, and March 13, 2022. We also conducted an updated systematic review and meta-analysis using PubMed, Scopus, Web of Science, Embase and the Cochrane Library up to February 22, 2023. Results In our cohort, a total of 76 patients were included [mean age (years): 57.2 ± 18.2, males: 39 (51.3), Black: 49 (64.5)]. Cangrelor was most used for embolization and intracranial stent placement (n = 24, 32%). Approximately 44% of our patients had a favorable outcome with a modified Rankin Scale (mRS) score of 0 to 2 at 90 days (n = 25/57); within 1 year, 8% of patients had recurrent or new strokes (n = 5/59), 6% had symptomatic intracranial hemorrhage [sICH] (4/64), 3% had major extracranial bleeding events (2/64), and 3% had a gastrointestinal bleed (2/64). In our meta-analysis, 11 studies with 298 patients were included. The pooled proportion of sICH and intraprocedural thromboembolic complication events were 0.07 [95% CI 0.04 to 1.13] and 0.08 [95% CI 0.05 to 0.15], respectively. Conclusion Our study found that intravenous cangrelor appears to be safe and effective in neuroendovascular procedures, with low rates of bleeding and ischemic events. However, further research is needed to compare different dosing and titration protocols of cangrelor and other intravenous agents.
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Affiliation(s)
- Harsh Desai
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Mohammed Maan Al-Salihi
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States
| | - Rami Z. Morsi
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Omar R. Vayani
- Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Sachin A. Kothari
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Sonam Thind
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | | | - Archit Baskaran
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Ammar Tarabichi
- Department of Neurology, DENT Neurologic Institute, Amherst, NY, United States
| | | | - James E. Siegler
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Mary Hahn
- Department of Neurology, Stony Brook University Hospital, Stony Brook, NY, United States
| | | | - James R. Brorson
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Scott J. Mendelson
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Ali Mansour
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Guilherme Dabus
- Department of Neurology, Baptist Cardiac and Vascular Institute, Miami, FL, United States
| | - Michael Hurley
- Department of Radiology, University of Chicago, Chicago, IL, United States
| | - Shyam Prabhakaran
- Department of Neurology, University of Chicago, Chicago, IL, United States
| | - Italo Linfante
- Department of Neurology, Baptist Cardiac and Vascular Institute, Miami, FL, United States
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, IL, United States
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Lu WZ, Lin HA, Hou SK, Bai CH, Lin SF. Efficacy and safety of tirofiban in patients with acute ischemic stroke treated with endovascular thrombectomy: A frequentist and Bayesian meta-analysis. Vascul Pharmacol 2023; 153:107244. [PMID: 37992511 DOI: 10.1016/j.vph.2023.107244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/10/2023] [Accepted: 11/13/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Tirofiban is an antiplatelet treatment approved for acute coronary syndrome, but it has not been rigorously evaluated for efficacy and safety in patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT). METHODS Electronic databases were systematically searched for studies conducted from January 1, 2015, to July 31, 2021, that evaluated tirofiban administration for patients with AIS treated with EVT in comparison with control. Risk ratios (RRs) and confidence intervals (CIs) were estimated for favorable functional outcomes (FFOs), mortality, and symptomatic intracranial hemorrhage (SICH), each 90 days after AIS. Bayesian hierarchical modeling was performed to obtain posterior RR and its 95% highest posterior density (HPD) for validation. RESULTS Compared with controls, tirofiban users exhibited increased FFOs (RR, 1.18; 95% CI, 1.08-1.30), decreased mortality (RR, 0.77; 95% CI, 0.64-0.92), and no difference in SICH (RR, 0.97; 95% CI, 0.77-1.23). Tirofiban users in the postbolus infusion subgroup exhibited increased FFOs (RR, 1.20; 95% CI, 1.07-1.35), decreased mortality (RR, 0.71; 95% CI, 0.58-0.88), and no increase in SICH (RR, 0.97; 95% CI, 0.72-1.29). The bolus-only subgroup showed no differences in FFO, mortality, or SICH between the tirofiban and control groups. Consistent results were obtained for posterior density of FFO (posterior RR, 1.20; 95% HPD, 1.06-1.34), mortality (posterior RR, 0.77; 95% HPD, 0.63-0.92), and SICH (posterior RR, 0.98; 95% HPD, 0.71-1.26). CONCLUSION For patients with AIS treated with EVT, tirofiban improved FFOs, decreased mortality, and did not increase SICH compared with controls; postbolus infusion for administering tirofiban was more favored than the bolus-only regimen.
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Affiliation(s)
- Wei-Zhen Lu
- Department of Emergency Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Feng Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan; School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan; Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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6
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Al-Salihi MM, Ayyad A, Al-Jebur MS, Al-Salihi Y, Saha R, Morsi RZ, Kass-Hout T, Kasab SA, Spiotta AM. Safety and efficacy of tirofiban in the management of stroke: A systematic review and meta-analysis of randomized controlled trials. Clin Neurol Neurosurg 2023; 232:107867. [PMID: 37423089 DOI: 10.1016/j.clineuro.2023.107867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/01/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND About 30 % of stroke patients have experienced unsuccessful reperfusion following endovascular therapy. Mechanical thrombectomy instruments may contribute to this by stimulating platelet aggregation. Tirofiban is a selective and rapidly activated antagonist of the platelets nonpeptide glycoprotein IIb/IIIa receptors that can reversibly suppress platelet aggregation. But, data from the medical literature are conflicting regarding its safety and efficacy for stroke patients. Hence, this study was designed to assess the safety and efficacy of tirofiban in stroke patients. METHODS Five major databases (PubMed, Scopus, Web of Science, Embase, and Cochrane library) were searched till December 2022. The Cochrane tool was used for risk of bias assessment, and the RevMan 5.4 was utilized for data analysis. RESULTS Seven RCTs with 2088 stroke patients were included. Tirofiban significantly increased the number of patients with mRS 0 score after 90 days than control; RR= 1.39, 95 %CI [1.15, 1.69]; p = 0.0006. Additionally, it reduced the NIHSS score after seven days; MD= -0.60, 95 %CI [-1.14, -0.06]; p = 0.03. However, tirofiban increased the incidence of intracranial haemorrhage (ICH); RR= 1.22, 95 %CI [1.03, 1.44]; p = 0.02. Other assessed outcomes showed insignificant results. CONCLUSIONS Tirofiban was associated with a higher mRS 0 score after three months and a lower NIHSS score after seven days. However, it is associated with higher ICH. Multicentric trials are required to provide more convincing proof of its utility.
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Affiliation(s)
- Mohammed Maan Al-Salihi
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA; College of Medicine/ University of Baghdad, Baghdad, Iraq; Department of Neurosurgery, Hamad General Hospital, Doha, Qatar.
| | - Ali Ayyad
- Department of Neurosurgery, Hamad General Hospital, Doha, Qatar; Department of Neurosurgery, Saarland University, Homburg, Germany
| | | | | | - Ram Saha
- Department of Neurology, Virginia Commonwealth University, VA, USA
| | - Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Tareq Kass-Hout
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Sami Al Kasab
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
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7
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Caroff J, Aubert L, Lavenu-Bombled C, Figueiredo S, Habchi K, Cortese J, Eugene F, Ognard J, Tahon F, Forestier G, Ifergan H, Zhu F, Hak JF, Reyre A, Laubacher M, Traore A, Desilles JP, Derraz I, Moreno R, Bintner M, Charbonnier G, Le Bras A, Veunac L, Gariel F, Redjem H, Sedat J, Tessier G, Dumas V, Gauberti M, Chivot C, Consoli A, Bricout N, Tuilier T, Guedon A, Pop R, Thouant P, Bellanger G, Zannoni R, Soize S, Richter JS, Heck O, Mihalea C, Burel J, Girot JB, Shotar E, Gazzola S, Boulouis G, Kerleroux B. Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey. J Neurointerv Surg 2023; 15:402-407. [PMID: 35347058 DOI: 10.1136/neurintsurg-2021-018601] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/15/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Neurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France. METHODS In April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC). RESULTS All 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications. CONCLUSION This nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.
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Affiliation(s)
- Jildaz Caroff
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Laurent Aubert
- Department of Anesthesia and Surgical Resuscitation Department, Bicetre Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Saclay, Le Kremlin-Bicetre, France
| | - Cécile Lavenu-Bombled
- Department of Biological Hematology, Assistance Publique-Hôpitaux de Paris, Faculté de médecine Paris Saclay, Hospital Bicetre, Le Kremlin-Bicetre, France
| | - Samy Figueiredo
- Department of Anesthesia and Surgical Resuscitation Department, Bicetre Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Saclay, Le Kremlin-Bicetre, France
| | - Kamelia Habchi
- Department of Anesthesia and Surgical Resuscitation Department, Bicetre Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Paris Saclay, Le Kremlin-Bicetre, France
| | - Jonathan Cortese
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | | | - Julien Ognard
- Department of Neuroradiology, CHU Brest, Brest, France
| | - Florence Tahon
- Department of Neuroradiology, Hôpital Privé Clairval, Marseille, France
| | | | - Heloise Ifergan
- Diagnostic and Interventional Neuroradiology, CHU Tours, Tours, France
| | - François Zhu
- Department of Diagnostic and Interventional Neuroradiology, CHU Nancy, Nancy, France.,Department of Neuroradiology, Hospices Civils de Lyon, Lyon, France
| | | | - Anthony Reyre
- Department of Neuroradiology, Hospital Timone, Marseille, France
| | | | - Abdoulaye Traore
- Department of Neuroradiology, Hôpital Louis Pasteur, Colmar, France
| | | | - Imad Derraz
- Department of Neuroradiology, CHU Montpellier, Montpellier, France
| | - Ricardo Moreno
- Department of Neuroradiology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marc Bintner
- Department of Neuroradiology, CHU de la Réunion, Saint-Denis, France
| | | | - Anthony Le Bras
- Department of Radiology, CH Bretagne Atlantique Site Chubert, Vannes, France
| | - Louis Veunac
- Department of Radiology, CH de la Cote Basque, Bayonne, France
| | - Florent Gariel
- Department of Interventional Neuroradiology, CHU Bordeaux GH Pellegrin, Bordeaux, France
| | - Hocine Redjem
- Department of Interventional Neuroradiology, Clinique des Cèdres, Toulouse, France
| | - Jacques Sedat
- Department of Interventional Neuroradiology, CHU Nice, Nice, France
| | | | - Victor Dumas
- Department of Radiology, CHU Poitiers, Poitiers, France
| | | | - Cyril Chivot
- Department of Neuroradiology, CHU Amiens-Picardie, Amiens, Hauts-de-France, France
| | - Arturo Consoli
- Department of Neuroradiology, Hospital Foch, Suresnes, France
| | - Nicolas Bricout
- Department of Interventional Neuroradiology, CHU Lille, Lille, France
| | - Titien Tuilier
- Department of Neuroradiology, CHU Henri Mondor, Créteil, France
| | - Alexis Guedon
- Department of Neuroradiology, CHU Lariboisiere Fernand-Widal, Paris, France
| | - Raoul Pop
- Department of Neuroradiology, CHU Strasbourg, Strasbourg, France
| | | | | | - Riccardo Zannoni
- Department of Neuroradiology, CHU Saint-Etienne, Saint-Etienne, France
| | | | | | - Olivier Heck
- Department of Neuroradiology, CHU Grenoble, Grenoble, France
| | - Cristian Mihalea
- Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
| | - Julien Burel
- Department of Radiology, CHU Rouen, Rouen, France
| | | | - Eimad Shotar
- Department of Neuroradiology, CHU Pitié Salpêtrière, Paris, France
| | - Sebastian Gazzola
- Department of Neuroradiology, Saint Anne Military Hospital, Toulon, France
| | | | - Basile Kerleroux
- Department of Neuroradiologie, Saint Anne Hospital, Paris, France
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8
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Al-bonayan A, Althakafy JT, Alorabi AQ, Alamrani NA, Aljuhani EH, Alaysuy O, Al-Qahtani SD, El-Metwaly NM. Novel Copper Oxide-Integrated Carbon Paste Tirofiban Voltammetric Sensor. ACS OMEGA 2023; 8:5042-5049. [PMID: 36777607 PMCID: PMC9909784 DOI: 10.1021/acsomega.2c07790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/09/2023] [Indexed: 06/18/2023]
Abstract
The present study introduced the construction and electroanalytical characterization of novel tirofiban (TIR) carbon paste voltammetric sensors integrated with copper oxide nanoparticles. The copper oxide nanostructure remarkably enhanced the oxidation of TIR molecules on the electrode surface with an irreversible anodic oxidation peak at about 1.18 V. The peak current values of the recorded differential pulse voltammograms were correlated to the TIR concentrations within a defined linear range from 0.060 to 7.41 μg mL-1 with an LOD value of 20.7 ng mL-1. Based on the electrochemical behavior of TIR at different scan rates and with the aid of the molecular orbital calculations performed on the TIR molecule, the electro-oxidation reaction was postulated to undergo through the oxidation of the five-membered-ring nitrogen atom with the transfer of one electron and one proton. Based on the reported selectivity and sensitivity of the proposed method, TIR was successfully determined in Aggrastat intravenous infusion and biological samples with mean average recoveries agreeable with the UV spectrophotometric method.
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Affiliation(s)
- Ameena
M. Al-bonayan
- Department
of Chemistry, Faculty of Applied Sciences, Umm Al-Qura University, Makkah21961, Saudi Arabia
| | - Jalal T. Althakafy
- Department
of Chemistry, Faculty of Applied Sciences, Umm Al-Qura University, Makkah21961, Saudi Arabia
| | - Ali Q. Alorabi
- Department
of Chemistry, Faculty of Sciences, Albaha
University, P.O. Box 1988, Albaha65799, Saudi Arbia
| | - Nasser A. Alamrani
- Department
of Chemistry, Faculty of Science, University
of Tabuk, Tabuk71474, Saudi Arabia
| | - Enas H. Aljuhani
- Department
of Chemistry, Faculty of Applied Sciences, Umm Al-Qura University, Makkah21961, Saudi Arabia
| | - Omaymah Alaysuy
- Department
of Chemistry, Faculty of Science, University
of Tabuk, Tabuk71474, Saudi Arabia
| | - Salhah D. Al-Qahtani
- Department
of Chemistry, College of Science, Princess
Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh11671, Saudi Arabia
| | - Nashwa M. El-Metwaly
- Department
of Chemistry, Faculty of Science, Mansoura
University, El-Gomhoria
Street, Mansoura35516, Egypt
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9
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Liu C, Yin L, Hu Y, Shi Z, Zhu Q, Xiao Q, Li G, Cheng J, Hou Y. Analysis of risk factors for the efficacy of tirofiban in the treatment of acute ischemic stroke. Neurol Res 2023; 45:538-543. [PMID: 36599001 DOI: 10.1080/01616412.2022.2164447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To analyse the risk factors for tirofiban efficacy in the early treatment of acute ischemic stroke. METHODS The clinical data of 204 patients with acute ischemic stroke treated with tirofiban were retrospectively analysed. The early efficacy of tirofiban was assessed by a ≥ 4-point decline in the National Institutes of Health Stroke Scale (NIHSS) score or via the complete disappearance of neurological deficits at the end of ischemic stroke treatment, and patients were divided into an effective groupand an ineffective group. Univariate and multivariate logistic regression analyses were used to compare the differences in clinical data between the two groups. RESULTS Multivariate logistic regression analysis showed that heavy drinking (OR 0.477, 95% CI 0.249-0.899, P = 0.023), elevated total cholesterol (OR 0.331, 95% CI 0.141-0.734, P = 0.008), NIHSS score at initiation of treatment (OR 1.130, 95% CI 1.026-1.253, P = 0.016) and time from onset to treatment (OR 0.839, 95% CI 0.700-0.979, P = 0.038) were independent risk factors affecting the early efficacy of tirofiban. CONCLUSION The early curative effect of tirofiban in acute ischemic stroke patients with a heavy drinking history and elevated total cholesterol was poor. In patients with acute ischemic stroke, the higher the NIHSS score was within a certain range (8 < NIHSS ≤15 and the Org 10,172 Trial in the Treatment of Acute Stroke (TOAST) belongs to small-artery occlusion lacunar) at the initiation of treatment and the shorter the time from onset to treatment, the better the early curative effect was.
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Affiliation(s)
- Chong Liu
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lu Yin
- Department of Rehabilitation, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yinqin Hu
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhizhen Shi
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qiaoyan Zhu
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Xiao
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guoyi Li
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiwei Cheng
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yangbo Hou
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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10
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Liu Q, Lu X, Yang H, Deng S, Zhang J, Chen S, Shi S, Xun W, Peng R, Lin B, Li T, Pan L, Weng B. Early tirofiban administration for patients with acute ischemic stroke treated with intravenous thrombolysis or bridging therapy: Systematic review and meta-analysis. Clin Neurol Neurosurg 2022; 222:107449. [PMID: 36162161 DOI: 10.1016/j.clineuro.2022.107449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/24/2022] [Accepted: 09/19/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In the present systematic review and meta-analysis, we sought to compare the efficacy and safety of tirofiban administered in patients with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT) with or without mechanical thrombectomy (MT). METHODS We searched PubMed, Web of Science, Embase and the Cochrane Library for randomized clinical trials and observational studies published between 2001 and 2021 that provided outcomes of AIS patients who underwent IVT alone or IVT bridging with or without tirofiban. The primary outcome was the proportion of patients achieving a modified Rankin Scale (mRS) score of 0-2 at 90 days. The secondary outcomes included the rates of (1) an excellent outcome defined as a mRS score of 0 or 1 at 90 days, (2) any type of intracranial hemorrhage (ICH), (3) symptomatic intracranial hemorrhage (sICH), (4) mortality, and (5) successful recanalization. RESULTS We included 722 patients with IVT bridging therapy in 3 trials; there were 171 patients in the tirofiban group and 551 patients in the nontirofiban group. We included 846 patients with IVT alone in 7 studies; there were 471 patients in the tirofiban group and 375 patients in the nontirofiban group. The patients treated with tirofiban had a reduced risk of mortality compared to the patients treated without tirofiban during IVT bridging (OR, 0.46; 95 % CI, 0.24-0.89; p = 0.02), but no significant differences were found in safety outcomes on sICH, ICH, recanalization or efficacy outcomes on modified Rankin scale 0-2 (p > 0.05). Pooled results showed that tirofiban combined with IVT alone did not increase the risks of sICH, ICH or mortality but was significantly associated with excellent (OR, 2.68; 95 % CI, 1.58-4.55; P = 0.0003) and favorable (OR, 2.36; 95 % CI, 1.58-3.52; p < 0.0001) functional outcomes at 90 days. CONCLUSION In AIS patients who underwent IVT or bridging therapy, early administration of tirofiban may be effective and safe, but further studies are needed to confirm the efficacy.
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Affiliation(s)
- Qianqian Liu
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Xianfu Lu
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Hong Yang
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Shan Deng
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Jian Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Shijian Chen
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Shengliang Shi
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China.
| | - Weiquan Xun
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Rihong Peng
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Baoquan Lin
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Tao Li
- Department of Radiology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Liya Pan
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
| | - Baohui Weng
- Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China.
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11
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Yu Y, Zheng Y, Dong X, Qiao X, Tao Y. Efficacy and safety of tirofiban in patients with acute ischemic stroke without large-vessel occlusion and not receiving intravenous thrombolysis: A randomized controlled open-label trial. JOURNAL OF NEURORESTORATOLOGY 2022. [DOI: 10.1016/j.jnrt.2022.100026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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12
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Anderson CS, Song L, Liu J. Therapeutic Strategies for Intracranial Atherosclerosis. JAMA 2022; 328:529-531. [PMID: 35943482 DOI: 10.1001/jama.2022.11525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Craig S Anderson
- The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- The George Institute for Global Health, China, Beijing, China
| | - Lili Song
- The George Institute for Global Health, Faculty of Medicine, UNSW Sydney, Sydney, Australia
- The George Institute for Global Health, China, Beijing, China
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Navy Medical University, Shanghai, China
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13
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Li W, Lin G, Xiao Z, Zhang Y, Li B, Zhou Y, Chai E. Safety and Efficacy of Tirofiban During Intravenous Thrombolysis Bridging to Mechanical Thrombectomy for Acute Ischemic Stroke Patients: A Meta-Analysis. Front Neurol 2022; 13:851910. [PMID: 35572929 PMCID: PMC9099208 DOI: 10.3389/fneur.2022.851910] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The safety and efficacy of tirofiban in intravenous thrombolysis (IVT) bridging to mechanical thrombectomy in patients with acute ischemic stroke (AIS) is unknown. The purpose of this meta-analysis was to evaluate the safety and efficacy of tirofiban in IVT bridging to mechanical thrombectomy in acute ischemic stroke. Methods We systematically searched PubMed, EMBASE, Web of Science, and The Cochrane Library, CNKI, and Wan Fang databases for randomized controlled trials and observational studies (case-control studies and cohort studies) comparing the tirofiban and non-tirofiban groups in AIS intravenous thrombolysis bridging to mechanical thrombectomy (Published by November 20, 2021). Our primary safety endpoints were symptomatic cerebral hemorrhage (sICH), intracranial hemorrhage (ICH), postoperative re-occlusion, and 3-month mortality; the efficacy endpoints were 3-month favorable functional outcome (MRS ≤ 2) and successful recanalization rate (modified thrombolytic therapy in cerebral infarction (mTICI) 2b or 3). Results A total of 7 studies with 1,176 patients were included in this meta-analysis. A comprehensive analysis of the included literature showed that the difference between the tirofiban and non-tirofiban groups in terms of successful recanalization (OR = 1.19, 95% Cl [0.69, 2.03], p = 0.53, I2 = 22%) and favorable functional outcome at 3 months (OR = 1.13, 95% Cl [0.81, 1.60], p = 0.47, I2 = 17%) in patients with IVT bridging mechanical thrombectomy of AIS was not statistically significant. Also, the differences in the incidence of sICH (OR = 0.97, 95% Cl [0.58, 1.62], p = 0.89) and ICH (OR = 0.83, 95% Cl [0.55, 1.24], p = 0.36) between the two groups were not statistically significant. However, the use of tirofiban during IVT bridging mechanical thrombectomy reduced the rate of postoperative re-occlusion (OR = 0.36, 95% Cl [0.14, 0.91], p = 0.03) and mortality within 3 months (OR = 0.54, 95% Cl [0.33, 0.87], p = 0.01) in patients. Conclusion The use of tirofiban during IVT bridging mechanical thrombectomy for AIS does not increase the risk of sICH and ICH in patients and reduces the risk of postoperative re-occlusion and mortality in patients within 3 months. However, this result needs to be further confirmed by additional large-sample, multicenter, prospective randomized controlled trials. Systematic Review Registration http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022297441.
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Affiliation(s)
- Wei Li
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
| | - Guohui Lin
- Day Treatment Center II of Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Zaixing Xiao
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
| | - Yichuan Zhang
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
| | - Bin Li
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
| | - Yu Zhou
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
- The First School of Clinical Medicine of Lanzhou University, Lanzhou, China
| | - Erqing Chai
- Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China
- Key Laboratory of Cerebrovascular Diseases in Gansu Province, Lanzhou, China
- *Correspondence: Erqing Chai
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14
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Zhang A, Wu N, Liu X, Jiang T. Continuous intravenous tirofiban can improve the 90-day functional outcome and decrease 90-day mortality without increasing bleeding risk in acute ischemic stroke patients treated by endovascular therapy: A meta-analysis. J Clin Neurosci 2022; 99:109-116. [PMID: 35278931 DOI: 10.1016/j.jocn.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The role of continuous intravenous administration of tirofiban in endovascular therapy is still unclear. This meta-analysis aims to evaluate the 90-day functional prognosis in acute ischemic stroke patients (AIS) treated by endovascular treatment and intravenous administration of tirofiban. METHODS We searched PubMed, Embase, and CENTRAL databases with the subject terms "tirofiban", "brain ischemia", and some related free words. Inclusion criteria were: (1) cohort study or randomized control trials; (2) AIS patients who received endovascular therapy; (3) the intervention or exposure was intravenous tirofiban monotherapy or combined with intra-arterial tirofiban; (4) containing data on modified Rankin Scale at 90 days and including at least one of the following indicators: mortality, symptomatic intracranial hemorrhage (sICH), intracranial hemorrhage (ICH), and recanalization. A summary odds ratio was calculated. RESULTS Twelve eligible studies, consisting of 3268 AIS participants, were identified. There was a significant trend of favorable outcomes (measured by mRS at three months) in the tirofiban group (ORs = 1.36; 95% CI = 1.09-1.70). In addition, compared with the non-tirofiban group, intravenous tirofiban was significantly associated with decreased risk of 90-day mortality (ORs = 0.73; 95% CI:0.59-0.89) and increased recanalization rate (ORs = 1.50; 95% CI:1.08-2.09) but no significant difference in rates of sICH (ORs = 0.93; 95% CI = 0.70-1.24) or ICH (ORs = 0.84; 95% CI = 0.62-1.15). CONCLUSIONS Intravenous tirofiban appears to be safe and effective when used following intra-arterial tirofiban or as monotherapy in AIS patients treated by endovascular therapy, which can improve the 90-day functional outcome, decrease the 90-day mortality and increase the possibility of early recanalization without increasing rates of sICH and ICH.
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Affiliation(s)
- Aiwu Zhang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Nihong Wu
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Xintong Liu
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Tao Jiang
- Department of Neurology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
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15
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Sun Y, Zheng H, Liu H, Jiang Z, Ren Y, Huang X, Wang L. Effect of Tirofiban on new cerebral microbleeds after mechanical thrombectomy in patients with acute ischemic stroke. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2021; 67:1564-1569. [PMID: 34909879 DOI: 10.1590/1806-9282.20210563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to analyze the effect of tirofiban on new cerebral microhemorrhage after mechanical thrombectomy in patients with acute ischemic stroke. METHODS In total, 203 patients with acute ischemic stroke treated by mechanical thrombectomy in our department of neurology were enrolled as the research objects. The patients were divided into two groups: the patients who used tirofiban within 24 h after surgery were assigned to the study group (78 subjects), while patients who did not use tirofiban were assigned to the conventional group (125 subjects). Magnetic resonance imaging was used to detect new-onset cerebral microbleeds in patients with stroke after surgery. The National Institute of Health Stroke Scale, modified ranking scale, and activity of daily living scale were used to assess the prognosis of patients, and the general data and the occurrence of adverse effects between two groups were compared to comprehensively evaluate the efficacy and safety of tirofiban. RESULTS The proportion of atrial fibrillation in the research group was significantly lower than that in the conventional group. The research group had a much lower rate of new-onset cerebral microbleeds than the conventional group (p<0.001). There was no significant difference in the proportion of adverse reactions between the two groups (p>0.05). CONCLUSION The application of tirofiban in mechanical thrombectomy of patients with acute ischemic stroke has high safety, effectively reduces the occurrence of new cerebral microhemorrhage, and provides a guarantee for patient safety.
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Affiliation(s)
- Yongdong Sun
- Jizhong Energy Fengfeng Group General Hospital, Department of Neurosurgery - Handan, China
| | - Hongjiang Zheng
- Jizhong Energy Fengfeng Group General Hospital, Department of Pathology - Handan, China
| | - Hui Liu
- Jizhong Energy Fengfeng Group General Hospital, Department of Neurosurgery - Handan, China
| | - Zhifeng Jiang
- Jizhong Energy Fengfeng Group General Hospital, Department of Neurosurgery - Handan, China
| | - Yongying Ren
- Jizhong Energy Fengfeng Group General Hospital, Department of Neurosurgery - Handan, China
| | - Xin Huang
- Jizhong Energy Fengfeng Group General Hospital, Department of Neurosurgery - Handan, China
| | - Lihua Wang
- Jizhong Energy Fengfeng Group General Hospital, Department of Neurosurgery - Handan, China
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16
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Liu J, Yang Y, Liu H. Efficacy outcomes and safety measures of intravenous tirofiban or eptifibatide for patients with acute ischemic stroke: a systematic review and meta-analysis of prospective studies. J Thromb Thrombolysis 2021; 53:898-910. [PMID: 34780001 DOI: 10.1007/s11239-021-02584-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 12/12/2022]
Abstract
To review the literature for randomized control trials (RCTs) and prospective cohort studies investigating the safety and efficacy of tirofiban and eptifibatide in patients with acute ischemic stroke (AIS). PubMed, Embase, and the Cochrane library were searched for available papers published up to September 2021. The efficacy was evaluated based on the 3-month favorable outcome [modified Rankin scale (mRS) = 0-1], functional outcome (mRS = 0-2), and the last available National Institutes of Health Stroke Scale (NIHSS) score measured in each study. Twelve studies (two RCTs and 10 prospective cohorts) and 2926 patients were included. Treatment with tirofiban or eptifibatide had no effects on the favorable outcome (RR = 1.09, 95% CI 0.89-1.35, P = 0.411), functional outcome (RR = 1.12, 95% CI 0.98-1.28, P = 0.010), and last available NIHSS (WMD = - 2.32, 95% CI - 5.14 to 0.50, P = 0.106), but might increase mortality (RR = 0.84, 95% CI 0.71-0.99, P = 0.121). The sensitivity analyses showed that the meta-analyses were robust. There was no significant publication bias. Tirofiban did not increase the risk of ICH (P = 0. 423) and sICH (P = 0. 990) but increased the risk of fatal ICH (RR = 3.59, 95% CI 1.62-7.96, P = 0.002). Thrombolysis/thrombectomy did not influence any of the outcomes. Adding tirofiban or eptifibatide to thrombolysis/thrombectomy was not significantly associated with a favorable outcome (mRS = 0-1) nor functional outcome (mRS = 0-2) in patients with AIS at 3 months, but might be associated with mortality, possibly due to fatal ICH. The NIHSS was also not significantly different between the intervention and control groups after treatments.
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Affiliation(s)
- Jingting Liu
- Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Yihong Yang
- Department of Emergency, Fuyang People's Hospital, Fuyang, 236000, China
| | - Hongbo Liu
- Department of Emergency, Fuyang People's Hospital, Fuyang, 236000, China.
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17
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Tao C, Zhu Y, Zhang C, Song J, Liu T, Yuan X, Luo W, Chen C, Liu D, Zhu Y, Liu J, Hu W. Association between tirofiban monotherapy and efficacy and safety in acute ischemic stroke. BMC Neurol 2021; 21:237. [PMID: 34167477 PMCID: PMC8223269 DOI: 10.1186/s12883-021-02268-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/04/2021] [Indexed: 01/11/2023] Open
Abstract
Background Studies have suggested that glycoprotein IIb/IIIa antagonists such as tirofiban are beneficial for patients with acute coronary syndromes. However, it is still uncertain about the efficacy and safety of tirofiban in patients with acute ischemic stroke (AIS). Methods In this prospective non-randomized study, 255 AIS patients were recruited from 4 comprehensive stroke centers in China between January, 2017 and May, 2018. Among them,169 patients were treated with aspirin plus clopidogrel and 86 patients were treated with tirofiban. The primary functional outcome was the distribution of the 90 days’ modified Rankin Scale (mRS). The safety outcomes included the incidence of intracranial hemorrhage (ICH) at discharge and mortality at 3 months. Results In the propensity score matched cohort, tirofiban alone was noninferior to the dual antiplatelet with regard to the primary outcome (adjusted common odds ratio, 0.97; 95% confidence interval, 0.46 to 2.04; P = 0.93). Mortality at 90 days was 10% in the dual antiplatelet group and 8% in the tirofiban group (adjusted odds ratio 0.75; 95% CI 0.08 to 7.40, p = 0.81). There was no difference of the ICH rate between two groups (adjusted odds ratio 0.44; 95% CI 0.13 to 1.48, p = 0.18). In the inverse probability of treatment weighting-propensity score-adjusted cohort, similar differences were found for functional and safety outcomes. Conclusions Our study suggested that tirofiban use appears to be safe as monotherapy in AIS treatment compared with common dual antiplatelet therapy, however, no improvement in functional outcomes was found. Trial registration Chinese clinical trial registry, ChiCTR2000034443, 05/07/2020. Retrospectively registered.
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Affiliation(s)
- Chunrong Tao
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Yuyou Zhu
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Chao Zhang
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Jianlong Song
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Tianlong Liu
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaodong Yuan
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Wenwu Luo
- Department of Pathology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Changchun Chen
- Department of Neurology, The Second People's Hospital of Anhui Province, Hefei, Anhui, China
| | - Dezhi Liu
- Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of TCM, 528 Zhang-Heng Road,Pu-Dong New Area, Shanghai, 201203, China
| | - Yuanyuan Zhu
- People's Hospital of LiXin County, BoZhou City, 236700, AnHui Province, China
| | - Jie Liu
- People's Hospital of LiXin County, BoZhou City, 236700, AnHui Province, China.
| | - Wei Hu
- Stroke Center & Department of Neurology, Division of Life Sciences and Medicine, the First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China.
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Aristizabal-Carmona BS, Lozada-Martinez ID, Torres-Llinás DM, Moscote-Salazar LR, García-Ballestas E, Agrawal A. Letter: Tirofiban Protocol Protects Against Delayed Cerebral Ischemia: A Case-Series Study. Neurosurgery 2021; 88:E453-E454. [PMID: 33555025 DOI: 10.1093/neuros/nyab002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/04/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Brayan S Aristizabal-Carmona
- Autonomous University Foundation of the Americas Pereira Colombia.,Medical-Surgical Research Center School of Medicine University of Cartagena Cartagena Colombia
| | - Ivan D Lozada-Martinez
- Medical-Surgical Research Center School of Medicine University of Cartagena Cartagena Colombia.,Latin American Council of Neurocritical Care (CLaNi) Cartagena Colombia.,Colombian Clinical Research Group in Neurocritical Care School of Medicine University of Cartagena Cartagena Colombia
| | - Daniela M Torres-Llinás
- Medical-Surgical Research Center School of Medicine University of Cartagena Cartagena Colombia
| | - Luis R Moscote-Salazar
- Medical-Surgical Research Center School of Medicine University of Cartagena Cartagena Colombia.,Latin American Council of Neurocritical Care (CLaNi) Cartagena Colombia.,Colombian Clinical Research Group in Neurocritical Care School of Medicine University of Cartagena Cartagena Colombia
| | - Ezequiel García-Ballestas
- Latin American Council of Neurocritical Care (CLaNi) Cartagena Colombia.,Biomedical Research Center School of Medicine University of Cartagena Cartagena Colombia
| | - Amit Agrawal
- All India Institute of Medical Sciences Bhopal, India
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19
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Piscopo A, Zanaty M, Hasan D. In Reply: Tirofiban Protocol Protects Against Delayed Cerebral Ischemia: A Case-Series Study. Neurosurgery 2021; 88:E455. [PMID: 33555023 DOI: 10.1093/neuros/nyab007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/11/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Anthony Piscopo
- Department of Neurosurgery University of Iowa Hospital and Clinics Iowa City, Iowa, USA
| | - Mario Zanaty
- Department of Neurosurgery University of Iowa Hospital and Clinics Iowa City, Iowa, USA
| | - David Hasan
- Department of Neurosurgery University of Iowa Hospital and Clinics Iowa City, Iowa, USA
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20
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Huo X, Raynald, Wang A, Mo D, Gao F, Ma N, Wang Y, Wang Y, Miao Z. Safety and Efficacy of Tirofiban for Acute Ischemic Stroke Patients With Large Artery Atherosclerosis Stroke Etiology Undergoing Endovascular Therapy. Front Neurol 2021; 12:630301. [PMID: 33643207 PMCID: PMC7905208 DOI: 10.3389/fneur.2021.630301] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 01/14/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients with large artery atherosclerosis (LAA) stroke etiology receiving endovascular therapy (EVT). Methods: In this multi-center prospective study, patients who were considered to have an indication received a low dose intra-arterial bolus (0.25–1 mg) of tirofiban. The safety and efficacy outcomes at 90-day follow-ups included symptomatic intracranial hemorrhage (sICH), recanalization rate, functional outcome, and mortality. Results: Among the 649 AIS patients with LAA, those in the tirofiban group (n = 244) showed higher systolic blood pressure (BP) and NIHSS score on admission, puncture-to-recanalization time, lower frequency of intravenous thrombolysis and intra-arterial thrombolysis, higher frequency of antiplatelet, heparinization, mechanical stent retrieval, aspiration, balloon angioplasty, and more retrieval times compared with those in the non-tirofiban group (n = 405) (all P < 0.05). Tirofiban was found to be associated with superior clinical outcomes in anterior circulation stroke and major stroke patients [adjusted odds ratio (OR) = 2.163, 95% confidence interval (CI) = 1.130–4.140, P = 0.02 and adjusted OR = 2.361, 95% CI = 1.326–4.202, P = 0.004, respectively] and a lower risk of mortality at 90-day follow-ups (adjusted OR = 0.159, 95% CI = 0.042–0.599, P = 0.007 and adjusted OR = 0.252, 95% CI = 0.103–0.621, P = 0.003, respectively). There was no significant difference in sICH between the two groups. Conclusions: Tirofiban in AIS patients with LAA undergoing EVT is safe and may benefit the functional outcomes in anterior circulation and major stroke patients and showed a trend for reduced mortality.
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Affiliation(s)
- Xiaochuan Huo
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Raynald
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Dapeng Mo
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhongrong Miao
- Neurointervention Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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21
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Zhang H, Zheng L. Statistical analysis for efficacy of tirofiban combined with ozagrel in the treatment of progressive cerebral infarction patients out of thrombolytic therapy time window. Clinics (Sao Paulo) 2021; 76:e2728. [PMID: 34133479 PMCID: PMC8183337 DOI: 10.6061/clinics/2021/e2728] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To investigate the safety and efficacy of combined tirofiban-ozagrel therapy for treating progressive stroke patients out of thrombolytic therapy time window. METHODS This prospective, double-blind, randomized controlled study included 337 patients who had experienced an acute ischemic stroke between November 2017 and December 2018. All patients were randomized into three groups: 1) the tirofiban/ozagrel group (n=113), 2) the tirofiban group (n=110), and 3) the ozagrel group (n=114). The platelet aggregation (PAG), thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB) levels in the patients from these groups were evaluated before starting treatment and then, at 24h, 7 days, and 14 days after treatment. The National Institutes of Health Stroke Scale (NIHSS) scores were evaluated before treatment and then, 24h, 1 week, 2 weeks, and 4 weeks after treatment. The Barthel Index (BI) score was used to measure safety, and the modified Rankin scale (mRS) was used to evaluate disability following 3 months of treatment. The risk factors affecting clinical outcomes were analyzed using logistic multivariate regression. RESULTS The mean NIHSS score for all the patients was 13.17±3.13 before treatment, and no significant difference between the basic clinical parameters of the three patient groups was found. Following treatment, both PAG and FIB were significantly reduced compared with the baseline (p<0.05). The levels of PAG and FIB in the tirofiban/ozagrel group were significantly lower than those in the tirofiban and ozagrel groups at 24h and 7 days after treatment (p<0.05). The NIHSS score decreased significantly in all treatment groups (p<0.05). The tirofiban/ozagrel NIHSS scores were significantly lower than that of the tirofiban and ozagrel groups at 24h, 1 week, and 2 weeks post initiation (p<0.05 for all). There were no significant differences in the BI and mRS scores or the intracranial hemorrhage rates; further, age, sex, Trial of ORG 10172 in acute stroke treatment (TOAST) type, baseline NIHSS and 24-h NIHSS scores, baseline thrombus-related factors, and treatment methods were shown to not be independent risk factors for clinical outcomes. CONCLUSION The combination of tirofiban and ozagrel, as well as monotherapy with either tirofiban or ozagrel, transiently improves the neural function of patients and reduces platelet aggregation and fibrinogen formation in the first 4 weeks following a stroke event; additionally, none of these treatments increased the risk for hemorrhage in these progressive stroke patients over a 3-month period.
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Affiliation(s)
- Huiying Zhang
- School of Statistics, ShanXi University of Finance & Economics, Taiyuan, Shanxi Province, 030006, China
| | - Lei Zheng
- Department of Cardiovascular Medicine, ShanXi Bethune Hospital, Taiyuan, Shanxi Province, 030032, China
- Corresponding author. E-mail:
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Sun Y, Guo ZN, Yan X, Wang M, Zhang P, Qin H, Wang Y, Zhu H, Yang Y. Safety and efficacy of tirofiban combined with endovascular therapy compared with endovascular therapy alone in acute ischemic stroke: a meta-analysis. Neuroradiology 2020; 63:17-25. [PMID: 32844236 DOI: 10.1007/s00234-020-02530-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022]
Abstract
Endovascular treatment (EVT) has been widely used for treating acute ischemic stroke (AIS). However, the safety and efficacy of treating AIS with tirofiban combined with EVT remain controversial. Therefore, we conducted a meta-analysis to evaluate this treatment. Randomized controlled trials and cohort studies that compared treatment with tirofiban combined with EVT and EVT alone were included in our meta-analysis. Those published from inception to March 31, 2020, were searched using the PubMed, Web of Science, Embase, and Cochrane Library databases. Safety was assessed based on symptomatic intracranial hemorrhage (sICH) incidence and 3-month mortality. Efficacy was assessed based on modified Rankin Scale (mRS) scores at 3 months post-EVT and recanalization rates. Data were analyzed using either the random-effects or fixed-effects model based on the heterogeneity of studies. In total, one RCT, six prospective studies, and four retrospective studies (2387 AIS cases) were assessed. Our meta-analysis showed that tirofiban combined with EVT did not increase sICH risk (RR, 1.06; 95%CI, 0.79 to 1.42; P = 0.72) and 3-month mortality (RR, 0.87; 95%CI, 0.74 to 1.04; P = 0.12). Recanalization rates were not significantly different between patients treated with tirofiban combined with EVT and those treated with EVT alone (RR, 1.04; 95%CI, 1.00 to 1.08; P = 0.07), but tirofiban combined with EVT was significantly associated with favorable functional outcomes (mRS score, 0-2) in AIS patients (RR, 1.13; 95%CI, 1.02 to 1.25; P = 0.02). Tirofiban combined with EVT appears to be safe and potentially effective in treating AIS.
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Affiliation(s)
- Yingying Sun
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Zhen-Ni Guo
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Xiuli Yan
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Meiqi Wang
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Peng Zhang
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Hongjing Zhu
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Yi Yang
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China.
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Wang H, Feng M. Influences of different dose of tirofiban for acute ST elevation myocardial infarction patients underwent percutaneous coronary intervention. Medicine (Baltimore) 2020; 99:e20402. [PMID: 32501985 PMCID: PMC7306376 DOI: 10.1097/md.0000000000020402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Tirofiban is widely used in patients with acute ST elevation myocardial infarction (STEMI) underwent percutaneous coronary intervention (PCI). This drug can efficiently improve myocardial perfusion and cardiac function, but its dose still remains controversial. We here investigated the effects of different dose of tirofiban on myocardial reperfusion and heart function in patients with STEMI. A total of 312 STEMI patients who underwent PCI in our hospital from March 2017 to March 2018 were enrolled and randomly divided into control group (75 cases, 0 μg/kg), low-dose group (79 cases, 5 μg/kg), medium-dose group (81 cases, 10 μg/kg) and high-dose group (77 cases, 20 μg/kg). The infarction-targeted artery flow grade evaluated by thrombolysis in myocardial infarction (TIMI), corrected TIMI frame count (CTFC) and sum-ST-segment resolution were recorded. At Day 7 and Day 30 after PCI, the left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter, left ventricular end systolic diameter, major adverse cardiovascular events and the hemorrhage and thrombocytopenia were also evaluated. After PCI, the rate of TIMI grade 3, CTFC and incidence of sum-ST-segment resolution > 50% of high-dose group were significantly higher than those of control group, low-dose group and medium-dose group (P < .05), and the CTFC of medium -dose group were significantly higher than that of control group, low-dose group (P < .05). Moreover, the LVEF, left ventricular end diastolic diameter and left ventricular end systolic diameter of high-dose group were significantly improved than those of other groups, and the LVEF of medium-dose group was significantly superior to that of low-dose group (P < .05). However, the incidence of major adverse cardiac events in high-dose group was significantly decreased, while the hemorrhage and incidence of thrombocytopenia of high-dose group were significantly higher than those of other 3 groups (P < .05). The tirofiban can effectively alleviate the myocardial ischemia-reperfusion injury and promote the recovery of cardiac function in STEMI patients underwent PCI. Although the high-dose can enhance the clinical effects, it also increased the hemorrhagic risk. Therefore, the rational dosage application of tirofiban become much indispensable in view of patient's conditions and hemorrhagic risk, and a medium dose of 10 μg/kg may be appropriate for patients without high hemorrhagic risk.
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Affiliation(s)
- Haixia Wang
- Department Pharmacy, the Second Clinical Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Meiqin Feng
- AstraZeneca (Wuxi) trading co. LTD, Wuxi, Jiangsu, China
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The Safety and Efficiency of Tirofiban in Acute Ischemic Stroke Patients Treated with Mechanical Thrombectomy: A Multicenter Retrospective Cohort Study. Biochem Res Int 2020; 2020:5656173. [PMID: 32399299 PMCID: PMC7211241 DOI: 10.1155/2020/5656173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/25/2020] [Accepted: 03/19/2020] [Indexed: 02/07/2023] Open
Abstract
Introduction Limited comparative studies have reported the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients after mechanical thrombectomy (MT). Additionally, the available studies are inconsistent with each other, which makes application of tirofiban unclear in neuro-intervention. Here, we performed a comparative retrospective study to investigate whether tirofiban combined with MT improves short- and long-term prognosis in AIS patients and whether its use is associated with complications. Method Retrospective data were collected for AIS patients admitted between January 2013 and January 2019 at three stroke centers. According to whether tirofiban was used during the operation, patients were divided into tirofiban group and control group. Multivariate and COX regression analyses were performed to determine the association of tirofiban treatment with safety and efficiency in subjects treated with MT. Result A total of 174 patients were analyzed, of whom 89 (51.1%) were treated with tirofiban. There were no differences in the incidence of symptomatic intracerebral hemorrhage (10.2% vs. 10.6%, p=0.918), parenchymal hemorrhage type 2 (18.0% vs. 16.5%, p=0.793), and reocclusion at 24 h (3.4% vs. 10.6%, p=0.060) between the tirofiban group and control group. Multivariate regression showed that tirofiban was not associated with intracerebral hemorrhage, early neurological deterioration, neurological improvement at 7 days, functional independence at 3-month and 9-month follow-up, or death at 9-month follow-up (adjusted p > 0.05 for all). However, AIS patients treated with MT + tirofiban showed a trend towards acquiring faster functional independence, with a median time to acquire functional independence of 4.0 months compared with 6.5 months in the control group (risk ratio = 1.49, 95% confidence interval 0.98–2.27; long rank p=0.066). Conclusion Tirofiban may help AIS patients given MT to gain functional independence faster, without increasing the risk of complications.
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