血管内治疗成功的患者中替罗非班静脉注射次数与症状性颅内出血的关联：RESCUE BT试验结果
Number of Retrieval Attempts and the Association of Intravenous Tirofiban with Symptomatic Intracranial Hemorrhage in Patients with Successful Endovascular Therapy: Results of the RESCUE BT Trial.
作者信息
Peng Xiangxiang, Guo Changwei, Yang Jie, Fan Shitao, Xu Xu, Ma Jinfu, Wang Zhixi, Yang Shihai, Zi Wenjie, Huang Xianjun, Wang Hongjun
机构信息
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, People's Republic of China.
Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, People's Republic of China.
出版信息
Clin Interv Aging. 2024 Nov 29;19:2001-2012. doi: 10.2147/CIA.S481084. eCollection 2024.
PURPOSE
To investigate the relationship between intravenous tirofiban, the number of retrieval attempts and symptomatic intracranial hemorrhage (sICH) in patients with successful EVT.
PATIENTS AND METHODS
We used the data from the Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke (RESCUE BT) Trial. The primary outcome was sICH, which was defined according to the Heidelberg Bleeding Classification. The association between the number of retrieval attempts and the rate of sICH was investigated using multivariable logistic regression.
RESULTS
A total of 866 patients were included in our analysis. In overall cohort, tirofiban (OR: 1.853, 95% CI: 1.039-3.307) and more than 2 passes (3 versus 0-1: OR: 2.482, 95% CI: 1.124-5.481; 2 versus 0-1: OR: 0.813, 95% CI: 0.389-1.696) were significantly associated with the occurrence of sICH. A significant interaction between the use of tirofiban and the increasing number of attempts was found (p for interaction = 0.02), whereby the presence of sICH was significantly associated with tirofiban (OR: 5.534, 95% CI: 1.586-19.315) in the subgroup of multiple passes (>2 passes group), while none was seen in the subgroup of 0-2 passes. The results of the sensitivity analysis also showed that more than 2 passes (3 versus 1: OR: 2.841, 95% CI: 1.102-7.323; 2 versus 1: OR: 0.852, 95% CI: 0.346-2.097) were significantly associated with the occurrence of sICH in the tirofiban group but not in the placebo group.
CONCLUSION
In patients with multiple attempts, intravenous tirofiban may increase the risk of sICH. Further research and individualized risk assessment are necessary to determine the most appropriate strategy of intravenous tirofiban for EVT patients, especially considering details of thrombectomy procedures.
REGISTRATION
: URL: http:// www.chictr.org.cn; Unique identifier: ChiCTR-INR-17014167.
目的
探讨成功进行血管内血栓切除术（EVT）的患者中静脉注射替罗非班、取栓尝试次数与症状性颅内出血（sICH）之间的关系。
患者与方法
我们使用了血管内治疗大血管闭塞性卒中患者使用与不使用替罗非班的对照试验（RESCUE BT试验）的数据。主要结局为sICH，根据海德堡出血分类进行定义。使用多变量逻辑回归研究取栓尝试次数与sICH发生率之间的关联。
结果
共有866例患者纳入我们的分析。在整个队列中，替罗非班（比值比：1.853，95%置信区间：1.039 - 3.307）以及超过2次取栓（3次取栓对比0 - 1次取栓：比值比：2.482，95%置信区间：1.124 - 5.481；2次取栓对比0 - 1次取栓：比值比：0.813，95%置信区间：0.389 - 1.696）与sICH的发生显著相关。发现替罗非班的使用与取栓尝试次数增加之间存在显著交互作用（交互作用p值 = 0.02），在多次取栓亚组（>2次取栓组）中，sICH的发生与替罗非班显著相关（比值比：5.534，95%置信区间：1.586 - 19.315），而在0 - 2次取栓亚组中未观察到这种关联。敏感性分析结果还显示，在替罗非班组中，超过2次取栓（3次取栓对比1次取栓：比值比：2.841，95%置信区间：1.102 - 7.323；2次取栓对比1次取栓：比值比：0.852，95%置信区间：0.346 - 2.097）与sICH的发生显著相关，而在安慰剂组中则不然。
结论
在多次尝试取栓的患者中，静脉注射替罗非班可能增加sICH的风险。有必要进行进一步研究和个体化风险评估，以确定针对EVT患者静脉注射替罗非班的最合适策略，尤其是考虑到血栓切除术操作的细节。
注册信息
网址：http:// www.chictr.org.cn；唯一标识符：ChiCTR - INR - 17014167。
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