Safety and efficacy of tirofiban combined with endovascular treatment in acute ischaemic stroke

Abstract

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.

Keywords: acute ischaemic stroke; endovascular treatment; functional outcome; intracerebral hemorrhage; tirofiban.