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October 1, 2023Neurosurgical FOCUSOpen Access

Association of tirofiban with improvement of functional outcomes of direct thrombectomy for acute anterior circulation occlusion: a retrospective, nonrandomized, multicenter, real-world study

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Key result

Tirofiban administered after direct thrombectomy significantly increased the rate of favorable functional outcomes at 90 days compared to thrombectomy alone in patients with acute ischemic stroke (53.9% vs 35.3%, adjusted OR 0.429).

Why the study?

Although tirofiban and endovascular thrombectomy are widely used in acute ischemic stroke, the effectiveness of their combined application remains debated.

Does tirofiban improve functional outcomes in patients with acute ischemic stroke undergoing direct thrombectomy for anterior circulation occlusion?

Population

204 patients undergoing direct thrombectomy for AIS with anterior circulation vessel occlusion

Comparison

Tirofiban vs no tirofiban

Design

Retrospective, nonrandomized, multicenter study

Follow-up

90 days

Authors

QGQiaochu GuanNanjing Drum Tower HospitalWYWenwei YunChangzhou No.2 People's HospitalXLXiaobo LiCentral South University

Discussion

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Member takes

Implication

Tirofiban may improve outcomes after direct thrombectomy; hypothesis-generating and leaves open need for randomized confirmation.

Study Design

Type

Cohort (n=204)

Multicenter

Yes

Structured PICO

Does tirofiban improve functional outcomes in patients with acute ischemic stroke undergoing direct thrombectomy for anterior circulation occlusion?

P
Population
204 patients aged 18 and older with acute ischemic stroke and anterior circulation large-vessel occlusion who underwent direct thrombectomy within 4.5 hours of onset, followed for 90 days.
E
Exposure
Tirofiban administered immediately after endovascular treatment via continuous intravenous infusion at 0.1 μg/kg/min for 12-24 hours following a low-dose intra-arterial bolus injection (0.25-1 mg).
C
Comparator
Direct endovascular thrombectomy without tirofiban.
O
Outcome
Functional outcome attained at 90 days posttreatment, defined as a modified Rankin Scale (mRS) score of 0-2 for a favorable functional outcome.hard clinical

Main Result

Odds Ratio: 0.429 (95% CI 0.207–0.888)

Absolute Event Rate: 53.9% vs 35.3%

p-value: p=0.023

Tirofiban administered after direct endovascular thrombectomy for acute ischemic stroke with anterior circulation occlusion significantly improved 90-day functional independence without increasing the risk of symptomatic intracerebral hemorrhage.

Limitations

  • Retrospective data collection, not a randomized controlled trial
  • Decision to administer tirofiban was made by treating physicians based on individual patient situations, introducing selection bias
  • Duration and maintenance of tirofiban administration varied among patients
  • Significant baseline differences between groups regarding age, sex, medical history, critical time points, surgical procedures, and antiplatelet drug selection
  • Retrospective design
  • Nonrandomized
  • Requires validation through future randomized controlled trials

Cite This Study

Guan et al. (2023) conducted a cohort in Acute ischemic stroke with anterior circulation vessel occlusion (n=204). Tirofiban vs. No tirofiban (direct thrombectomy alone) was evaluated on Favorable functional outcome at 90 days (modified Rankin Scale score of 0-2) (adjusted OR 0.429, 95% CI 0.207-0.888, p=0.023). Tirofiban administered after direct thrombectomy significantly increased the rate of favorable functional outcomes at 90 days compared to thrombectomy alone in patients with acute ischemic stroke (53.9% vs 35.3%, adjusted OR 0.429).

synapsesocial.com/papers/6a77172edf493903fd1ea8abhttps://doi.org/10.3171/2023.7.focus23150
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Also Consider

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