Effect of tirofiban arterial injection on neurological and endothelial function in acute ischemic stroke patients beyond the thrombolysis time window

Abstract

Objective: To evaluate the efficacy and safety of arterial tirofiban injection in patients with acute ischemic stroke (AIS) beyond the thrombolysis time window.

Methods: In this retrospective single-center study, clinical data were analyzed from 230 AIS patients treated at the First Hospital of Yulin between July 2021 and January 2023. Patients were divided into two groups: the observation group (n=102) treated with tirofiban combined with dual antiplatelet therapy, and the control group (n=128) that received dual antiplatelet therapy alone. Post-treatment follow-up evaluated neurological function, endothelial function, and safety using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI). Endothelial function was assessed by measuring levels of endothelin-1 (ET-1), nitric oxide (NO), and von Willebrand factor (vWF). Baseline characteristics, treatment protocols, and complications were analyzed to ensure the reliability and scientific rigor of the results.

Results: Compared to the control group, the observation group demonstrated significant improvements in NIHSS, mRS, and BI scores, indicating enhanced neurological function and self-care ability. Endothelial markers (ET-1, NO, and vWF) also significantly improved in the observation group, suggesting a beneficial effect on endothelial function. The overall efficacy rate at 90 days was 86.72% in the observation group, significantly higher than the 74.50% in the control group (P<0.05). In terms of safety, there were no significant differences in the incidence of adverse events between the two groups, indicating that tirofiban is well-tolerated. Multivariate analysis identified age, treatment protocol, and baseline NO levels as independent factors affecting the 90-day prognosis, underscoring the importance of individualized treatment strategies for AIS patients.

Conclusion: Arterial injection of tirofiban significantly improves neurological and endothelial function in AIS patients beyond the thrombolysis time window while maintaining a favorable safety profile. These findings support the use of tirofiban in patients who are ineligible for intravenous thrombolysis or endovascular treatment.

Keywords: Tirofiban; acute ischemic stroke; endothelial function; neurological function; safety; thrombolysis.

Figure 1

Multivariate logistic analysis of factors affecting 90-day prognosis in patients. Note: NO, Nitric Oxide; NIHSS, National Institutes of Health Stroke Scale.

Figure 2

ROC curves of significant risk factors in predicting 90-day prognosis in patients. A: Treatment Plan (AUC=0.685, 95% CI: 0.579-0.736, Cut-off =0.730, Sensitivity =0.700, Specificity =0.611); B: Age (AUC=0.851, 95% CI: 0.759-0.905, Cut-off =68.5, Sensitivity =0.789, Specificity =0.874); C: Hypertension (AUC=0.603, 95% CI: 0.553-0.695, Cut-off =0.690, Sensitivity =0.750, Specificity =0.489); D: NIHSS before treatment (AUC=0.641, 95% CI: 0.607-0.705, Cut-off =6.00, Sensitivity =0.743, Specificity =0.711); E: NO1 before treatment (AUC=0.672, 95% CI: 0.569-0.764, Cut-off =44.6, Sensitivity =0.765, Specificity =0.537). Note: NO, Nitric Oxide; NIHSS, National Institutes of Health Stroke Scale.