Can Tirofiban Improve the Outcome of Patients With Acute Ischemic Stroke: A Propensity Score Matching Analysis.
Can Tirofiban Improve the Outcome of Patients With Acute Ischemic Stroke: A Propensity Score Matching Analysis.
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DOI：
10.3389/fneur.2021.688019
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发表时间：
2021
影响因子：
3.4
通讯作者：
Qian C
中科院分区：
文献类型：
--
作者：
Cai L;Yu X;Yu J;Xu J;Xu L;Ling C;Lou M;Yu C;Qian C
目的：评价替罗非班治疗急性缺血性卒中(AIS)尤其是后循环卒中(PCS)的疗效和安全性。方法：我们纳入了2016年1月至2020年5月期间连续接受大动脉闭塞(LAO)并接受机械血栓摘除术(MT)的AIS患者。根据移植中是否使用替罗非班将患者分为两组。主要疗效结果是良好的功能结果，定义为3个月时改良Rankin评分(MRS)0~2分。安全性结果为3个月时的死亡率、颅内出血(ICH)和症状性颅内出血(SICH)的发生率。队列采用1：1倾向得分匹配(PSM)进行平衡。亚组分析进一步比较替罗非班在前循环卒中(ACS)组和PCS组中的疗效和安全性。结果：292例患者进入本研究，分为替罗非班组(n=51)和非替罗非班组(n=241)。在倾向评分匹配的队列中，替罗非班组的优良率高于非替罗非班组(49.0vs.25.5%，p=0.014)，3个月死亡率下降趋势更大(15.6vs.33.3%，p=0.064)。替罗非班组和对照组之间SICH和ICH的风险相同(分别为17.6vs.27.4%p=0.236，31.3vs.45.1%p=0.154)。多因素Logistic回归分析显示，替罗非班的使用预示着良好的结果[调整后的优势比=2.87，95%可信区间为1.52-6.44，p=0.043]。亚组分析显示，在急性冠脉综合征中，替罗非班的使用与良好的预后显著相关(AOR=3.66，95%CI1.24~5.22，p=0.019)，而在PCS中则不相关(AOR=1.12，95%CI0.47~7.52，p=0.570)。结论：我们证明替罗非班可能与改善接受MT的AIS患者的良好结局有关，而不会增加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的结果无关，需要更全面的随机对照试验来证实这一发现。
Objective: To evaluate the efficacy and safety of tirofiban for patients with acute ischemic stroke (AIS), especially posterior circulation stroke (PCS). Methods: 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. Results: A total of 292 patients were eligible for this study and divided into the tirofiban group (n = 51) and the no-tirofiban group (n = 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%, p = 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% p = 0.064). The risk of sICH and ICH was the same between the tirofiban and control groups (17.6 vs. 27.4% p = 0.236, 31.3 vs. 45.1% p = 0.154, respectively). Tirofiban use was predictive of favorable outcomes [adjusted odds ratio (aOR) = 2.87, 95% confidence interval (CI) 1.52–6.44, p = 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, p = 0.019) but not in PCS (aOR = 1.12, 95% CI 0.47–7.52, p = 0.570). Conclusion: 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.
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