Key result
Adding tirofiban to dual antiplatelet therapy significantly reduced the NIHSS score at 7 days compared to dual antiplatelet therapy alone in patients with branch atheromatous disease and early neurological deterioration.
Why the study?
The effectiveness and safety of adding tirofiban or argatroban after early neurological deterioration in patients with branch atheromatous disease receiving dual antiplatelet therapy remained to be evaluated.
Does adding tirofiban or argatroban to dual antiplatelet therapy improve neurological outcomes in patients with branch atheromatous disease experiencing early neurological deterioration?
Cohort (n=135)
Yes
Does adding tirofiban or argatroban to dual antiplatelet therapy improve neurological outcomes in patients with branch atheromatous disease experiencing early neurological deterioration?
Absolute Event Rate: 3.32% vs 5.62%
p-value: p=<0.001
Adding intravenous tirofiban to dual antiplatelet therapy in patients with branch atheromatous disease who experience early neurological deterioration significantly improves 90-day functional outcomes and reduces neurological deficits without increasing bleeding risk.
May improve early deficits in this cohort; leaves open need for RCTs to confirm 90-day outcomes and safety.
Objective We evaluated the effectiveness and safety of adding tirofiban or argatroban after early neurological deterioration (END) in patients with branch atheromatous disease (BAD) receiving dual antiplatelet therapy and compared the outcomes with those of patients who continued dual antiplatelet therapy alone. Methods This retrospective study focused on 135 consecutive patients with BAD and END between June 2020 and June 2022. The primary and secondary efficacy endpoints were a modified Rankin scale (mRS) score ≤ 2 at 90 days after stroke and a National Institutes of Health Stroke Scale (NIHSS) score on day 7 after END. Safety outcomes included other bleeding and mortality events. Results A total of 65, 33, and 37 patients were included in the dual antiplatelet therapy (DAPT), argatroban, and tirofiban groups, respectively. There was a statistically significant difference in the clinical outcome (mRS 0–2) among the three groups (P = 0.001). Post-hoc test analysis showed that the proportion of good outcomes in the tirofiban group was significantly higher than that in the argatroban and DAPT group (P = 0.011, < 0.001, Bonferroni corrected). The NIHSS score of the tirofiban group (3.32 ± 1.81) on day 7 was significantly lower than that of the argatroban (6.24 ± 3.18) and DAPT (5.62 ± 3.25) groups (P < 0.01). No severe bleeding and mortality events were observed in any of the three groups. Conclusion Following END in patients with BAD receiving dual antiplatelet therapy, adding tirofiban to the original treatment can help reverse the progress and improve outcomes.
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Zhong et al. (2023) conducted a cohort in Branch atheromatous disease with early neurological deterioration (n=135). Tirofiban or Argatroban added to dual antiplatelet therapy vs. Dual antiplatelet therapy alone was evaluated on NIHSS score on day 7 after early neurological deterioration (p=<0.001). Adding tirofiban to dual antiplatelet therapy significantly reduced the NIHSS score at 7 days compared to dual antiplatelet therapy alone in patients with branch atheromatous disease and early neurological deterioration.
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