Early tirofiban therapy following intravenous thrombolysis was associated with lower odds of early neurological deterioration (6.1% vs 12.5%; adjusted OR 0.2; 95% CI 0.1-0.8).
Observational (n=319)
Does early tirofiban reduce early neurological deterioration in acute ischemic stroke patients treated with intravenous thrombolysis?
Early tirofiban therapy following intravenous thrombolysis in acute ischemic stroke patients is associated with reduced early neurological deterioration without increasing bleeding risk.
Effect estimate: adjusted OR 0.2 (95% CI 0.1-0.8)
Absolute Event Rate: 6.1% vs 12.5%
Abstract BACKGROUND: Patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) are at high risk of early neurological deterioration (END) due to increased platelet activation. OBJECTIVES: The objective of the study was to investigate the safety and efficacy of early antiplatelet therapy in reducing END postthrombolysis, and identify patients who may benefit. METHODS: In this observational study, AIS patients receiving IVT were stratified into the early tirofiban group and the control group according to antiplatelet therapy during the first 24 h following IVT. The primary endpoint was END 4 (the National Institutes of Health Stroke Scale score increase ≥ 4 points) within 72 h following IVT. Binary logistic regression with propensity-score-matching was applied to analyze outcomes between the groups. RESULTS: Of the 319 patients enrolled, 66 in the early tirofiban group and 120 matched controls were analyzed. END 4 occurred in four patients (6.1%) with early tirofiban and 15 patients (12.5%) in the control group. Early tirofiban administration was associated with lower odds of END 4 (adjusted odd ratio, 0.2; 95% confidence interval, 0.1–0.8). Intracranial hemorrhage occurred in 2 (3.0%, none symptomatic) and 3 (2.5%, 2 symptomatic) patients, respectively, with no significant association between early tirofiban and major bleeding or mortality. Early tirofiban was significantly correlated with reduced END 4 among patients aged 66–80 years, those without prestroke antiplatelet therapy, and those with neutral response to IVT (adjusted P < 0.05). CONCLUSION: Early tirofiban therapy following IVT was associated with reduced END without increased bleeding risk. Specific patient subgroups may potentially benefit from early antiplatelet therapy, further confirmation is needed.
Wang et al. (Sat,) conducted a observational in acute ischemic stroke (n=319). early tirofiban vs. control was evaluated on early neurological deterioration (END 4, NIHSS score increase ≥ 4 points) within 72 h following IVT (adjusted OR 0.2, 95% CI 0.1-0.8). Early tirofiban therapy following intravenous thrombolysis was associated with lower odds of early neurological deterioration (6.1% vs 12.5%; adjusted OR 0.2; 95% CI 0.1-0.8).