Safety and Efficacy of Tirofiban in Severe Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke with anterior circulation large artery occlusion undergoing mechanical thrombectomy (n=285). Intervention: Tirofiban vs. No tirofiban during mechanical thrombectomy. Primary outcome: Favorable functional outcome defined as modified Rankin Scale (mRS) score of 0-2 at 90 days (aOR 2.033, 95% CI 1.002~4.123, p=0.043).

Q: What does this research mean for the field?

Tirofiban administration is associated with higher rates of favorable functional outcome without increasing hemorrhage or mortality risks in acute ischemic stroke patients undergoing mechanical thrombectomy, particularly among those with severe deficits (NIHSS > 14). Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Lingxin Cai; Tingting Wang; Aiqing Chen; Chenhan Ling; Jing Xu; Cong Qian; Gao Chen

doi:10.3390/jcdd9110408

November 21, 2022Journal of Cardiovascular Development and DiseaseOpen Access

Safety and Efficacy of Tirofiban in Severe Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

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Key result

Tirofiban linked to ~2-fold higher odds of favorable 90-day functional outcome after thrombectomy.

aOR 2.033
95% CI 1.002~4.123
P=0.043
n=285

Figures

Why the study?

Benefits of tirofiban varied across studies depending on patient condition, leaving the characteristics of patients who obtain the largest benefits not well analyzed.

Does adjunctive tirofiban improve 90-day favorable functional outcomes (mRS 0-2) without increasing intracranial hemorrhage in acute ischemic stroke patients undergoing mechanical thrombectomy?

Key Points

To evaluate the efficacy and safety of tirofiban in acute ischemic stroke patients undergoing mechanical thrombectomy and identify patient characteristics linked to the greatest benefit.
Retrospective cohort analysis of 285 acute ischemic stroke patients undergoing mechanical thrombectomy, comparing 48 patients treated with tirofiban against 237 who were not.
Multivariable adjusted logistic regression and subgroup analyses were used to evaluate 90-day functional outcomes and safety endpoints.
The primary efficacy endpoint was a favorable outcome defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days; safety endpoints included intracranial hemorrhage, symptomatic intracranial hemorrhage, and 90-day mortality.
A favorable outcome occurred in 54.1% of tirofiban-treated patients compared with 37.9% of untreated patients, showing an independent positive association after adjustment (aOR 2.033, 95% CI 1.002~4.123, p = 0.043).
In subgroup analysis, tirofiban was associated with favorable outcomes in patients with NIHSS > 14 (aOR 2.778, 95% CI 1.056~7.356, p = 0.038), but not in those with NIHSS ≤ 14 (aOR 1.719, 95% CI 0.646~4.578, p = 0.278; p for interaction = 0.028).

Study Design

Type

Cohort (n=285)

Multicenter

No

Structured PICO

Does adjunctive tirofiban improve 90-day favorable functional outcomes (mRS 0-2) without increasing intracranial hemorrhage in acute ischemic stroke patients undergoing mechanical thrombectomy?

P

Population

285 patients (median age 71, 61.7% female) with acute ischemic stroke from anterior circulation large artery occlusion undergoing mechanical thrombectomy within 12 hours of onset, followed for 90 days.

E

Exposure

Intravenous tirofiban (10 µg/kg bolus followed by continuous infusion at 8 µg/kg/h for 24 hours, followed by dual antiplatelet therapy after ruling out ICH on head CT) administered at physician discretion as rescue therapy during mechanical thrombectomy (n=48)

C

Comparator

Mechanical thrombectomy without tirofiban administration (n=237)

O

Outcome

Favorable functional outcome defined as a modified Rankin Scale (mRS) score of 0-2 at 90 dayshard clinical

Main Result

Odds Ratio: 2.033 (95% CI 1.002–4.123)

Absolute Event Rate: 54.1% vs 37.9%

p-value: p=0.043

Adjunctive tirofiban during mechanical thrombectomy was associated with improved 90-day functional independence without increasing intracranial hemorrhage, particularly among patients with severe ischemic stroke (NIHSS > 14).

Limitations

Retrospective study design with a risk of selection bias
Post-hoc subgroup analyses may lack statistical power and findings may be accidental
Small sample size precluded a more detailed subgroup analysis according to NIHSS score
Unmeasured confounding from prognostic factors such as collateral status, specific location of infarction, and remaining penumbral tissue
Time from onset to puncture was derived from patient/family statements in medical records and may be inaccurate
Retrospective study with risk of selection bias
Post-hoc subgroup analyses may lack power
Small sample size precluded more detailed NIHSS subgroup analysis
Potential unmeasured confounders (collateral status, specific infarction location, remaining penumbral tissue) were not included
Inaccurate/unreliable time from onset to puncture based on medical records derived from patient and family statements

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Implication

Tirofiban may improve 90-day outcomes after thrombectomy; leaves open confirmation and safety in randomized trials.

Abstract

Tirofiban has recently shown encouraging efficacy and safety among acute ischemic stroke (AIS) patients with mechanical thrombectomy (MT). However, the benefits of tirofiban varied among studies depending on the patient’s condition, which was often not well analyzed. This study aimed to identify the characteristics of patients who may obtain the largest benefits from tirofiban. The efficacy endpoint was a favorable outcome defined as a modified Rankin Scale (mRS) score of 0~2 at 90 days. The safety endpoints were intracranial hemorrhage (ICH), symptomatic intracranial hemorrhage (sICH) and mortality at 90 days. Adjusted logistic regression analysis and subgroup analyses were utilized to investigate the factors associated with tirofiban and the outcome. All of 285 patients fit the inclusion criteria. Tirofiban was associated with a higher rate of favorable outcome (aOR 2.033, 95% CI, 1.002~4.123, p = 0.043) but not with an increased risk of ICH, sICH or mortality (p > 0.05). Moreover, subgroup analyses revealed that tirofiban was associated with favorable outcomes in patients with NIHSS > 14 (aOR 2.778, 95% CI 1.056~7.356, p = 0.038) but not in patients with NIHSS ≤ 14 (aOR 1.719, 95% CI 0.646~4.578, p = 0.278). No significant heterogeneity was found in the effect of tirofiban across the subgroups of age, sex, ASPECTS, time from onset to puncture, use of t-PA or stroke etiology (p for interaction > 0.05). The administration of tirofiban was associated with favorable outcomes in severe ischemic stroke patients, and further studies are needed to confirm this finding.

Discussion

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Cite This Study

Cai et al. (2022) conducted a cohort in Acute ischemic stroke with anterior circulation large artery occlusion undergoing mechanical thrombectomy (n=285). Tirofiban vs. No tirofiban during mechanical thrombectomy was evaluated on Favorable functional outcome defined as modified Rankin Scale (mRS) score of 0-2 at 90 days (aOR 2.033, 95% CI 1.002~4.123, p=0.043). Tirofiban was associated with a higher rate of 90-day favorable functional outcome (mRS 0-2) in acute ischemic stroke patients undergoing mechanical thrombectomy.

synapsesocial.com/papers/6a777478a0847c3df1ec7d11 https://doi.org/10.3390/jcdd9110408

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Safety and Efficacy of Tirofiban in Severe Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Safety and Efficacy of Tirofiban in Severe Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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