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Intravenous tirofiban therapy for patients with capsular warning syndrome
Wei Li1, Ya Wu1, Xiao-Shu Li1
1Department of Neurology, Daping Hospital & Research Institute of Surgery, The Army Military Medical University, Chongqing, China.
Insights
Intravenous tirofiban effectively treated capsular warning syndrome (CWS) by reducing recurrent attacks and improving patient outcomes. This therapy offers a safe and promising option for managing CWS symptoms.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Pharmacology
Background:
- Capsular warning syndrome (CWS) involves recurrent transient ischemic attacks.
- Current therapies for CWS are limited, necessitating novel treatment approaches.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous tirofiban for treating CWS.
- To compare tirofiban treatment with other available therapies for CWS.
Main Methods:
- A retrospective review of CWS patients treated between January 2013 and September 2017.
- Patients received either intravenous tirofiban or other standard treatments.
- Outcomes measured included recurrent attacks, NIHSS scores, and mRS scores; safety was assessed for bleeding events.
Main Results:
- The tirofiban group showed a lower rate of recurrent attacks (26.7%) compared to the non-tirofiban group (62.5%).
- Patients treated with tirofiban had significantly better NIHSS scores at 24 hours (73.3% with score 0) and favorable mRS at 3 months.
- No significant adverse events like intracerebral hemorrhage or systemic bleeding were observed in either group.
Conclusions:
- Intravenous tirofiban demonstrates potential as an effective and safe treatment for CWS.
- Tirofiban may help stabilize early symptoms and reduce functional deficits in CWS patients.
Background:
Capsular warning syndrome (CWS) is defined as recurrent episodes of transient ischaemic attacks ≥3 times during a short time frame. There is no effective therapy to stop these attacks. We, herein, report our experience of using intravenous tirofiban to treat CWS.
Methods:
All patients with CWS in our hospital from January 2013 to September 2017 were reviewed. Patients in tirofiban group (T-group) were treated by intravenous tirofiban at 0.4 μg/kg/min for 30 min followed by 0.1-0.15 µg/kg/min infusion. Other treatments (non-T-group) included thrombolytic, oral antiplatelet agents and anticoagulant. Intracerebral haemorrhage (ICH), systematic bleeding, new attacks after treatment, National Institutes of Health Stroke Scale (NIHSS) scores at 24 hours and modified Rankin Scales (mRSs) at 3 months were recorded. Descriptive statistics were used for analysis.
Results:
Of 23 patients qualified (15 in T-group, 8 in non-T-group), the duration of symptoms ranged from 2 to 100 min before treatments. After treatment, in T-group, four patients (26.7%) had recurrent attacks, and NIHSS scores were 0 in 11 patients (73.3%) at 24 hours. All patients reached a favourable outcome (mRS ≤2 at 3 months. In non-T-group, five patients (62.5%) had new attacks. NIHSS scores were 0 in two patients (25%) at 24 hours. At 3 months, seven patients (87.5%) reached a favourable outcome. Neither ICH nor systematic bleeding or thrombocytopaenia occurred in both groups of patients.
Conclusions:
Intravenous tirofiban can be a potentially effective and safe therapy to stop early symptomatic fluctuations and shorten the duration of functional deficits in patients with CWS.
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