Cai Lingxin, Yu Xiaobo, Yu Jun, Xu Jing, Xu Liang, Ling Chenhan, Lou Min, Yu Cheng, Qian Cong
Department of Neurological Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
Front Neurol. 2021 Sep 13;12:688019. doi: 10.3389/fneur.2021.688019. eCollection 2021.
To evaluate the efficacy and safety of tirofiban for patients with acute ischemic stroke (AIS), especially posterior circulation stroke (PCS). We enrolled consecutive patients with AIS who suffered large artery occlusion (LAO) and underwent mechanical thrombectomy (MT) between January 2016 and May 2020. Patients were divided into two groups according to whether tirofiban was used during MT. The primary efficacy outcome was a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at 3 months. The safety outcomes were the rate of mortality at 3 months and the presence of intracranial hemorrhage (ICH) and symptomatic intracranial hemorrhage (sICH). Cohorts were balanced using 1:1 propensity score matching (PSM). Subgroup analysis was further performed to compare the efficacy and safety of tirofiban between the anterior circulation stroke (ACS) and PCS groups. A total of 292 patients were eligible for this study and divided into the tirofiban group ( = 51) and the no-tirofiban group ( = 241). In the propensity-score-matched cohort, the tirofiban group had a higher rate of favorable outcomes than the no-tirofiban group (49.0 vs. 25.5%, = 0.014), and the mortality at 3 months showed a greater downward trend in the tirofiban group than the no-tirofiban group (15.6 vs. 33.3% = 0.064). The risk of sICH and ICH was the same between the tirofiban and control groups (17.6 vs. 27.4% = 0.236, 31.3 vs. 45.1% = 0.154, respectively). Tirofiban use was predictive of favorable outcomes [adjusted odds ratio (aOR) = 2.87, 95% confidence interval (CI) 1.52-6.44, = 0.043] after multiple logistic regression analysis. Subgroup analysis revealed that tirofiban use was significantly associated with favorable outcomes in ACS (aOR = 3.66, 95% CI 1.24-5.22, = 0.019) but not in PCS (aOR = 1.12, 95% CI 0.47-7.52, = 0.570). We demonstrated that tirofiban may be associated with improving favorable outcome for the AIS patients who underwent MT, without increasing ICH or sICH. Furthermore, our results indicated that for PCS patients tirofiban may not be associated with favorable outcome, and more comprehensive randomized controlled trials are needed to confirm this finding.
评估替罗非班用于急性缺血性卒中（AIS）患者，尤其是后循环卒中（PCS）患者的疗效和安全性。我们纳入了2016年1月至2020年5月期间连续发生大动脉闭塞（LAO）并接受机械取栓（MT）的AIS患者。根据MT期间是否使用替罗非班将患者分为两组。主要疗效结局为良好的功能结局，定义为3个月时改良Rankin量表（mRS）评分为0 - 2分。安全性结局为3个月时的死亡率、颅内出血（ICH）和症状性颅内出血（sICH）的发生情况。采用1:1倾向评分匹配（PSM）使队列达到平衡。进一步进行亚组分析以比较替罗非班在前循环卒中（ACS）组和PCS组之间的疗效和安全性。共有292例患者符合本研究条件，分为替罗非班组（ = 51）和非替罗非班组（ = 241）。在倾向评分匹配队列中，替罗非班组的良好结局发生率高于非替罗非班组（49.0%对25.5%， = 0.014），且替罗非班组3个月时的死亡率下降趋势比非替罗非班组更明显（15.6%对33.3%， = 0.064）。替罗非班组和对照组之间sICH和ICH的风险相同（分别为17.6%对27.4%， = 0.236；31.3%对45.1%， = 0.154）。经过多因素逻辑回归分析，使用替罗非班可预测良好结局[调整优势比（aOR） = 2.87，95%置信区间（CI）1.52 - 6.44， = 0.043]。亚组分析显示，使用替罗非班与ACS患者的良好结局显著相关（aOR = 3.66，95% CI 1.24 - 5.22， = 0.019），但与PCS患者无关（aOR = 1.12，95% CI 0.47 - 7.52， = 0.570）。我们证明，替罗非班可能与改善接受MT的AIS患者的良好结局相关，且不增加ICH或sICH。此外，我们的结果表明，对于PCS患者，替罗非班可能与良好结局无关，需要更全面的随机对照试验来证实这一发现。
