Tirofiban Protocol Protects Against Delayed Cerebral Ischemia: A Case-Series Study

Area of Science:

• Neurology
• Neurosurgery
• Pharmacology

Background:

• Delayed cerebral ischemia (DCI) remains a significant complication following aneurysmal subarachnoid hemorrhage (aSAH) with limited effective prophylactic options beyond nimodipine.
• Platelet inhibition presents a potential strategy to mitigate DCI by preventing microthrombus formation.
• Tirofiban, with its established safety profile and controlled platelet inhibition, has been explored as a monotherapy bridge for DCI prophylaxis.

Purpose of the Study:

• To evaluate the efficacy and safety of a tirofiban infusion protocol in reducing the risk of DCI in patients with aSAH.
• To compare DCI rates and associated complications in aSAH patients treated with tirofiban versus those without antiplatelet therapy.

Main Methods:

• A retrospective analysis of aSAH patients treated between December 2010 and March 2019.
• Patients treated with stent-assisted coiling or flow-diverting devices received a continuous tirofiban infusion protocol.
• Comparison with a control group undergoing coil embolization without antiplatelet therapy, with safety analysis for DCI, hemorrhagic, and ischemic events.

Main Results:

• The tirofiban group (21 patients) showed a significant 72% reduction in the risk of vasospasm compared to the control group (81 patients).
• Tirofiban did not increase the risk of hemorrhagic complications and showed a trend towards reducing symptomatic stroke risk.
• While DCI, older age, and postprocedural stroke predicted mortality, tirofiban demonstrated a non-significant trend in reducing mortality risk.

Conclusions:

• The tirofiban protocol in aSAH patients effectively reduces the risk of DCI without introducing additional safety concerns.
• Findings support the role of antiplatelet therapy, specifically tirofiban, in DCI prophylaxis, aligning with previous experimental and clinical evidence.