Safety and Efficacy of Tirofiban During Mechanical Thrombectomy for Stroke Patients with Preceding Intravenous Thrombolysis

• Main Authors: Huo X, Yang M, Ma N, Gao F, Mo D, Li X, Wang A, Wang Y, Miao Z
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-07-01
• Series: Clinical Interventions in Aging
• Subjects: acute ischemic stroke; mechanical thrombectomy; intravenous thrombolysis; tirofiban; bridging therapy.
• Online Access: https://www.dovepress.com/safety-and-efficacy-of-tirofiban-during-mechanical-thrombectomy-for-st-peer-reviewed-article-CIA

Xiaochuan Huo,1,2,* Ming Yang,1,2,* Ning Ma,1,2 Feng Gao,1,2 Dapeng Mo,1,2 Xiaoqing Li,1,2 Anxin Wang,2,3 Yongjun Wang,2,3 Zhongrong Miao1,2 1Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2China National Clinical Research Center for Neurological Diseases, Beijing, People’s Republic of China; 3Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhongrong MiaoBeijing Tiantan Hospital, Capital Medical University, No. 119, the South Fourth Ring West Road, Beijing, Fengtai District 100070, People’s Republic of ChinaEmail [e-mail]: Whether tirofiban is safe and effective for acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) with preceding intravenous thrombolysis (IVT) remains unclear. We aim to evaluate the safety and efficacy of tirofiban during MT for patients with preceding IVT.Patients and Methods: Patients who underwent MT and preceding IVT were derived from the ANGEL registry and were dichotomized into tirofiban and non-tirofiban group according to whether rescue tirofiban was performed. The safety endpoints were sICH, total ICH and distal embolization. The efficacy endpoints were arterial recanalization, three-month functional independence (modified Rankin Scale [mRS]: 0– 2) and mortality.Results: We included 207 MT patients with preceding IVT from the entire registry. Among them, there were 55 in tirofiban group and 152 in non-tirofiban group, and 17 (8.2%) patients suffered sICH and 36 (17.4%) suffered ICH within 24 hours post-MT; 11 (5.3%) distal embolization of thrombus; 111 (53.6%) achieved functional independence and 34 (16.4%) died after three-month follow-up. No significant differences in safety outcomes on sICH, ICH and distal embolization of thrombus and efficacy outcomes on recanalization and long-term functional independence were found between tirofiban and non-tirofiban group for the entire cohort (p> 0.05 for all groups). Tirofiban was correlated with long-term mortality reduction for patients underwent MT and preceding IVT (adjusted hazard ratio 0.28 [0.08– 0.94], adjusted p=0.03).Conclusion: In AIS patients who underwent MT and preceding IVT, rescue tirofiban was not correlated with increased risk of safety endpoints on sICH, ICH or distal embolization of thrombus, and might be associated with a lower risk of long-term mortality. Further study is needed to confirm the effect of early antiplatelet therapy with tirofiban for patients underwent MT and preceding IVT.Keywords: acute ischemic stroke, mechanical thrombectomy, intravenous thrombolysis, tirofiban, bridging therapy