替罗非班在接受机械取栓治疗的急性缺血性卒中患者中的安全性和有效性：一项多中心回顾性队列研究。
The Safety and Efficiency of Tirofiban in Acute Ischemic Stroke Patients Treated with Mechanical Thrombectomy: A Multicenter Retrospective Cohort Study.
作者信息
Zhao Lili, Jian Yating, Li Tao, Wang Heying, Lei Zhang, Sun Man, Li Ye, Zhang Yiheng, Dang Meijuan, Huqing Wang, Hong Sun, Ru Zhang, Zhang Hongxing, Jia Yi, Guogang Luo, Guilian Zhang
机构信息
Department of Neurology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China.
Department of Neurology, The First Affliated Hospital of Xi'an Jiaotong University, Xi'an 710000, Shaanxi, China.
出版信息
Biochem Res Int. 2020 Apr 27;2020:5656173. doi: 10.1155/2020/5656173. eCollection 2020.
INTRODUCTION
Limited comparative studies have reported the safety and efficacy of tirofiban in acute ischemic stroke (AIS) patients after mechanical thrombectomy (MT). Additionally, the available studies are inconsistent with each other, which makes application of tirofiban unclear in neuro-intervention. Here, we performed a comparative retrospective study to investigate whether tirofiban combined with MT improves short- and long-term prognosis in AIS patients and whether its use is associated with complications.
METHOD
Retrospective data were collected for AIS patients admitted between January 2013 and January 2019 at three stroke centers. According to whether tirofiban was used during the operation, patients were divided into tirofiban group and control group. Multivariate and COX regression analyses were performed to determine the association of tirofiban treatment with safety and efficiency in subjects treated with MT.
RESULT
A total of 174 patients were analyzed, of whom 89 (51.1%) were treated with tirofiban. There were no differences in the incidence of symptomatic intracerebral hemorrhage (10.2% 10.6%, =0.918), parenchymal hemorrhage type 2 (18.0% . 16.5%, =0.793), and reocclusion at 24 h (3.4% . 10.6%, =0.060) between the tirofiban group and control group. Multivariate regression showed that tirofiban was not associated with intracerebral hemorrhage, early neurological deterioration, neurological improvement at 7 days, functional independence at 3-month and 9-month follow-up, or death at 9-month follow-up (adjusted > 0.05 for all). However, AIS patients treated with MT + tirofiban showed a trend towards acquiring faster functional independence, with a median time to acquire functional independence of 4.0 months compared with 6.5 months in the control group (risk ratio = 1.49, 95% confidence interval 0.98-2.27; long rank =0.066).
CONCLUSION
Tirofiban may help AIS patients given MT to gain functional independence faster, without increasing the risk of complications.
引言
有限的比较研究报告了替罗非班在急性缺血性卒中（AIS）患者机械取栓（MT）后的安全性和有效性。此外，现有研究结果相互矛盾，这使得替罗非班在神经介入治疗中的应用尚不清楚。在此，我们进行了一项比较性回顾性研究，以调查替罗非班联合MT是否能改善AIS患者的短期和长期预后，以及其使用是否与并发症相关。
方法
收集2013年1月至2019年1月期间在三个卒中中心住院的AIS患者的回顾性数据。根据手术期间是否使用替罗非班，将患者分为替罗非班组和对照组。进行多变量和COX回归分析，以确定替罗非班治疗与接受MT治疗患者的安全性和有效性之间的关联。
结果
共分析了174例患者，其中89例（51.1%）接受了替罗非班治疗。替罗非班组和对照组在症状性脑出血发生率（10.2%对10.6%，P=0.918）、2型实质出血（18.0%对16.5%，P=0.793）和24小时再闭塞率（3.4%对10.6%，P=0.060）方面无差异。多变量回归显示，替罗非班与脑出血、早期神经功能恶化、7天时神经功能改善情况、3个月和9个月随访时的功能独立性或9个月随访时的死亡均无关联（所有调整后的P>0.05）。然而，接受MT+替罗非班治疗的AIS患者显示出更快获得功能独立性的趋势，获得功能独立的中位时间为4.0个月，而对照组为6.5个月（风险比=1.49，95%置信区间0.98-2.27；长秩检验P=？066）。
结论
替罗非班可能有助于接受MT治疗的AIS患者更快地获得功能独立性，而不会增加并发症风险。 （注：原文中“long rank =0.066”处“？”为未明确的符号，保留原文形式）
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