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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion.
Wenjie Zi1, Jiaxing Song1, Weilin Kong1
1From the Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University) (W.Z., J.S., W.K., J.H., C.G., Z.Q., C.Y., L.L., Yan Tian, Dahong Yang, J.Y., J.H., F.L., Q.Y.), Guangyang Bay Laboratory, Chongqing Institute for Brain and Intelligence (W.Z., F.L., Q.Y.), the Department of Neurology, People's Hospital of Chongqing Banan District (M.T.), the Department of Neurology, Chongqing University Fuling Hospital (De Yang), No. 2 Department of Internal Medicine, Chongqing Sanbo Chang'an Hospital (J.Z.), the Department of Neurology, Youyang County People's Hospital (S.X., T.C.), and the Department of Neurology, Second Affiliated Hospital of Chongqing Medical University (C.L.), Chongqing, the Department of Neurology, Guiping People's Hospital, Guiping (W.H.), the Department of Neurology, Bazhong Hospital of Traditional Chinese Medicine (Y.Y.), the Department of Neurology, Bazhong Central Hospital (B.L.), the Department of Neurology, People's Hospital of Pingchang (J.L.), and the Department of Neurology, Nanjiang Hospital of Traditional Chinese Medicine (J.M.), Bazhong, the Department of Neurology, Suining First People's Hospital, Suining (B.Z), the Department of Neurology, Taihe County People's Hospital (W.G.), and the Department of Neurology, Taihe County Hospital of Traditional Chinese Medicine (Z.L.), Fuyang, the Department of Neurology, Meishan Second People's Hospital, Meishan (X.T.), the Department of Neurology, Qian Xi Nan People's Hospital, Qian Xi Nan (Yaoyu Tian), the Department of Neurology, Jingdezhen No. 1 People's Hospital, Jingdezhen (M.C.), the Department of Neurology, Xingyi People's Hospital, Xingyi (D.C.), the Department of Encephalopathy, Maoming Hospital of Traditional Chinese Medicine, Maoming (W.H.), the Department of Neurology, Weihai Municipal Hospital, Weihai (P.W.), the Department of Neurology, Liangshan First People's Hospital, Xichang (Z.Y.), the Department of Neurology, People's Hospital of Luyi, Zhoukou (H.L.), the Department of Neurology, People's Hospital of Zunyi City Bo Zhou District, Zunyi (S.Y.), the Department of Neurology, Wuhan Hospital of Traditional Chinese and Western Medicine (W.L.), and the Department of Neurology, Third People's Hospital of Hubei Province, (Y.W.), Wuhan, the Department of Neurology, First Affiliated Hospital of Wannan Medical College, Wuhu (X.H.), the Department of Cerebrovascular Diseases, Guangyuan Central Hospital, Guangyuan (S.L), the Department of Neurology, Mianyang Central Hospital (Y. Tang), the Department of Cerebrovascular Diseases, Sichuan Mianyang 404 Hospital (J.L.), the Department of Neurology, People's Hospital of Zitong County (M.W.), and the Department of Neurology, Sichuan Science City Hospital (Y.P.), Mianyang, the Department of Neurology, Chongzhou People's Hospital, Chengdu (Y.W.), the Department of Neurology, Xian XD Group Hospital, Xi'an (L.Y.), the Department of Neurology, Southern Medical University-affiliated Dongguan People's Hospital, Dongguan (Z.S.), the Department of Neurology, People's Hospital of Nanbu County (P.H.), and the Department of Neurology, Affiliated Hospital of North Sichuan Medical College (Z.L.), Nanchong, the Department of Neurology, Second People's Hospital of Mengjin District, Luoyang (H.Z.), the Department of Neurology, Mianzhu People's Hospital, Deyang (Z.C.), the Department of Neurology, Zigong First People's Hospital, Zigong (Q.S.), the Department of Neurology, Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Qingyuan (X.C.), the Department of Cerebrovascular Diseases, People's Hospital of Yuxi City, Yuxi (F.H.), the Department of Neurology, First People's Hospital of Yibin, Yibin (H.L.), the Department of Neurology, People's Hospital of Mengzi, Hani-Yi Autonomous Prefecture of Honghe, Mengzi (W.X.); and the Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang (J.M.) - all in China; University of Pittsburgh Medical Center Stroke Institute, Departments of Neurology and Neurosurgery, University of Pittsburgh School of Medicine, Pittsburgh (R.G.N.); the Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom (D.W.); and the Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles (J.L.S.).
Tirofiban improved outcomes in acute ischemic stroke patients without large vessel occlusion, showing a higher rate of excellent recovery compared to aspirin. While generally safe, tirofiban had a slightly increased risk of intracranial hemorrhage.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Glycoprotein IIb/IIIa receptor inhibitors like tirofiban have not been extensively studied in acute ischemic stroke patients without large or medium-sized vessel occlusion.
- Acute ischemic stroke management often focuses on reperfusion therapies, leaving a gap in understanding treatments for non-occlusive cases.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous tirofiban compared to low-dose aspirin in patients with acute ischemic stroke and no large or medium-sized vessel occlusion.
- To determine if tirofiban improves functional outcomes and quality of life in this specific stroke population.
Main Methods:
- A multicenter trial in China enrolled patients with ischemic stroke, NIH Stroke Scale score ≥5, limb weakness, and no large vessel occlusion.
- Patients received either intravenous tirofiban or oral aspirin for 2 days, followed by aspirin for 90 days.
- The primary efficacy endpoint was an excellent outcome (modified Rankin Scale score 0-1) at 90 days; safety endpoints included death and symptomatic intracranial hemorrhage.
Main Results:
- A significantly higher percentage of patients achieved an excellent outcome with tirofiban (29.1%) compared to aspirin (22.2%) (adjusted risk ratio, 1.26; P=0.02).
- Most patients had small, presumed atherosclerotic infarctions.
- Mortality rates were similar between groups, but symptomatic intracranial hemorrhage occurred in 1.0% of the tirofiban group versus 0% in the aspirin group.
Conclusions:
- Intravenous tirofiban was associated with a greater likelihood of an excellent outcome compared to low-dose aspirin in patients with recent-onset or progressing stroke and non-occluded cerebral vessels.
- While effective, tirofiban use was linked to a slightly higher incidence of intracranial hemorrhages, necessitating careful consideration of risks and benefits.
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