替罗非班联合血管内治疗在急性缺血性脑卒中中的安全性和有效性。
Safety and efficacy of tirofiban combined with endovascular treatment in acute ischaemic stroke.
机构信息
Department of Pharmacy, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.
出版信息
Eur J Neurol. 2019 Aug;26(8):1105-1110. doi: 10.1111/ene.13946. Epub 2019 Mar 19.
BACKGROUND AND PURPOSE
Tirofiban is used off-label in clinical practice for acute ischaemic stroke (AIS). However, it is unknown whether tirofiban increases the bleeding risk or improves the outcome of endovascular treatment (EVT) in AIS. This study evaluated the efficacy and safety of tirofiban in combination with EVT for AIS.
METHODS
Consecutive patients with AIS receiving EVT were included in the prospective stroke registry from 2015 to 2018. The efficacy outcomes were modified Rankin Scale (mRS) score at 3 months and National Institutes of Health Stroke Scale (NIHSS) score at 24 h. The safety outcomes were symptomatic intracerebral hemorrhage (sICH), any in-hospital intracerebral hemorrhage, in-hospital death and 3-month death.
RESULTS
Of 211 patients, 82 (38.9%) received tirofiban. A total of 39 (48.1%) with tirofiban and 44 (36.1%) without tirofiban had mRS score 0-2 [adjusted odds ratio (OR), 2.41; 95% confidence interval (CI), 1.11-5.23, P = 0.026]. NIHSS score at 24 h was lower in the tirofiban group (9.5 vs. 12.0, adjusted P = 0.032). Five (6.1%) patients with tirofiban and 16 (12.4%) without tirofiban had sICH (adjusted OR, 0.54; 95% CI, 0.16-1.83, P = 0.32). In-hospital intracerebral hemorrhage occurred in 10 (12.2%) patients with tirofiban and 41 (31.8%) without tirofiban (adjusted OR, 0.32; 95% CI, 0.13-0.76, P = 0.01). In-hospital death occurred in 7 (8.5%) patients with tirofiban and 16 (12.4%) without tirofiban (adjusted OR, 0.69; 95% CI, 0.22-2.13, P = 0.52). A total of 13 (15.9%) patients with tirofiban and 22 (17.1%) without tirofiban were dead at 3 months (adjusted OR, 0.98; 95% CI, 0.40-2.40, P = 0.96).
CONCLUSIONS
Tirofiban in combination with EVT was associated with a lower mRS score at 3 months and NIHSS score at 24 h. It was not associated with a higher rate of sICH, in-hospital death and death at 3 months.
背景与目的
替罗非班在临床实践中被超适应证用于急性缺血性脑卒中（AIS）。然而，替罗非班是否会增加血管内治疗（EVT）的出血风险或改善 AIS 的结局尚不清楚。本研究评估了替罗非班联合 EVT 治疗 AIS 的疗效和安全性。
方法
2015 年至 2018 年，连续纳入接受 EVT 的 AIS 患者进入前瞻性卒中登记。疗效结局为 3 个月时改良 Rankin 量表（mRS）评分和 24 h 时国立卫生研究院卒中量表（NIHSS）评分。安全性结局为症状性颅内出血（sICH）、任何院内颅内出血、院内死亡和 3 个月死亡。
结果
211 例患者中，82 例（38.9%）接受了替罗非班治疗。替罗非班组共有 39 例（48.1%）和未用替罗非班组 44 例（36.1%）mRS 评分为 0-2[调整优势比（OR），2.41；95%置信区间（CI），1.11-5.23，P=0.026]。替罗非班组 24 h 的 NIHSS 评分较低（9.5 比 12.0，调整 P=0.032）。替罗非班组有 5 例（6.1%）和未用替罗非班组有 16 例（12.4%）发生 sICH（调整 OR，0.54；95%CI，0.16-1.83，P=0.32）。替罗非班组有 10 例（12.2%）和未用替罗非班组有 41 例（31.8%）发生院内颅内出血（调整 OR，0.32；95%CI，0.13-0.76，P=0.01）。替罗非班组有 7 例（8.5%）和未用替罗非班组有 16 例（12.4%）发生院内死亡（调整 OR，0.69；95%CI，0.22-2.13，P=0.52）。替罗非班组有 13 例（15.9%）和未用替罗非班组有 22 例（17.1%）在 3 个月时死亡（调整 OR，0.98；95%CI，0.40-2.40，P=0.96）。
结论
替罗非班联合 EVT 可降低 3 个月时 mRS 评分和 24 h 时 NIHSS 评分。但与 sICH、院内死亡和 3 个月死亡的发生率增加无关。
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