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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.01100

Safety and efficacy of tirofiban combined with mechanical thrombectomy depend on ischemic stroke etiology

Chao Sun1, Zheng Zhao2, Xiang Li1, Xiangliang Chen2, Chaoping Huang3, Xuemei Li4, Yajie Shan4, Yang Zou5,  Yukai Liu2, Mako Ibrahim1, Linda Nyame1, Baili Song1, Fusang Wang1, Xiaohan Zheng1, Jue Hu3, Zhihong Zhao4,  Junshan Zhou2 and  Jianjun Zou2*
  • 1China Pharmaceutical University, China
  • 2Nanjing Hospital affiliated to Nanjing Medical University, China
  • 3Changsha Central Hospital, China
  • 4Hunan Provincial People's Hospital, China
  • 5The University of Melbourne, Australia

Background and Purpose: The clinical use of tirofiban for patients with acute ischemic stroke (AIS) who underwent mechanical thrombectomy (MT) remains controversial. We aimed to evaluate the safety and efficacy of tirofiban combined with MT in AIS patients.
Methods: Patients with AIS who underwent MT from January 2014 to December 2018 were enrolled in three stroke units in China. Subgroup analyses were performed based on stroke etiology which was classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Safety outcomes were in-hospital intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH) and mortality at 3-month. Efficacy outcomes were favorable functional outcome and functional independence at 3-month and neurological improvement at 24 h, 3 d and discharge.
Results: In patients with large artery atherosclerosis (LAA) stroke, multivariate analyses revealed that tirofiban significantly decreased the odds of in-hospital ICH (adjusted OR=0.382, 95% CI 0.180-0.809) and tended to increase the odds of favorable functional outcome at 3-month (adjusted OR=3.050, 95% CI 0.969-9.598). By contrast, in patients with cardioembolism (CE) stroke, tirofban was not associated with lower odds of in-hospital ICH and higher odds of favorable functional outcome at 3-month (adjusted P>0.05 each), however, the association between tirofiban treatment and lower odds of neurological improvement at 24h and 3d were significant (adjusted OR<0.05 each).
Conclusions: Tirofiban combined with MT appears to be safe and effective in LAA patients, but has no beneficial effect on CE patients.

Keywords: Acute ischemic stroke, Mechanical thrombectomy, Tirofiban, Safety, efficacy

Received: 20 Jun 2019; Accepted: 01 Oct 2019.

Copyright: © 2019 Sun, Zhao, Li, Chen, Huang, Li, Shan, Zou, Liu, Ibrahim, Nyame, Song, Wang, Zheng, Hu, Zhao, Zhou and Zou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Jianjun Zou, Nanjing Hospital affiliated to Nanjing Medical University, Nanjing, 211166, Jiangsu Province, China, zoujianjun100@126.com