Treatment of progressive ischemic stroke with low‑dose eptifibatide: A retrospective case‑control study

Abstract

Progressive ischemic stroke (PIS) is a therapeutic challenge in clinical practice. The present retrospective study aimed to investigate the safety and effectiveness of eptifibatide in the treatment of PIS. The present study enrolled patients with PIS admitted to Xiangtan Central Hospital (Xiangtan, China) between March 2020 and March 2021 with National Institutes of Health Stroke Scale (NIHSS) progression scores of ≥2 points during the initial 72 h. Patients were then divided into two groups according to their different anti-platelet treatment regimens. The control group was administered anti-platelet aggregation with aspirin 100 mg/day, or aspirin 100 mg/day in combination with clopidogrel 75 mg/day, whilst eptifibatide was administered in the eptifibatide group in addition to the treatment regimen used in the control group. Changes in NIHSS scores at the time of progression and 7 days after treatment (∆NIHSS) were used to assess early neurological recovery, and there were no significant differences in ∆NIHSS and adverse reactions between the groups (P>0.05). Subgroup analysis was subsequently performed according to the type of blood vessel that was involved [large artery atherosclerosis (LAA) or small artery occlusion (SAO)]. For the SAO subgroup, the ∆NIHSS in the eptifibatide group was significantly superior to that of the control group (P=0.008), while for the LAA subgroup, there were no significant differences in ∆NIHSS between groups (P=0.334). The present retrospective study found that patients with PIS tolerated eptifibatide treatment well. Eptifibatide exerted different effects on patients with acute PIS involving different types of blood vessels compared with oral antiplatelet drugs. In addition, application of eptifibatide may lead to faster and earlier recovery in patients with SAO, but not in those with LAA. Low-dose eptifibatide is a safe and effective treatment option for patients with PIS caused by SAO.

Keywords: antiplatelet drugs; eptifibatide; glycoprotein IIb/IIIa inhibitor; progressive stroke; treatment.

Figure 1

Representative CT and MRI images of two patients enrolled into the present study. A 64-year-old patient in the eptifibatide group. (A) Head CT at 13 h after progressive ischemic stroke onset (eptifibatide was administered at 17 h after onset). Head MRI (B) T1 and (C) T2 sequences on day 4 after onset showing patchy haemorrhagic areas (arrow). Head routine CT scans of a 70-year-old man in the control group on (D) day 2 and (E) day 5 after onset, with punctate haemorrhagic areas (arrow).