Safety and efficacy of tirofiban combined with endovascular treatment in acute ischaemic stroke
Safety and efficacy of tirofiban combined with endovascular treatment in acute ischaemic stroke
复制标题
替罗非班联合血管内治疗治疗急性缺血性脑卒中的安全性和有效性
DOI：
10.1111/ene.13946
复制
发表时间：
2019-08-01
影响因子：
5.1
通讯作者：
Yang, J.
中科院分区：
文献类型：
--
作者：
Pen, X.;Zheng, D.;Yang, J.
背景和目的替罗非班用于临床治疗急性缺血性卒中(AIS)。然而，目前尚不清楚替罗非班是否增加了AIS的出血风险或改善了血管内治疗(EVT)的结果。本研究评价替罗非班联合EVT治疗AIS的疗效和安全性。方法将2015-2018年间连续接受EVT治疗的AIS患者纳入前瞻性卒中登记。3个月时用改良朗金量表(MRS)评分，2 4h用美国国立卫生研究院卒中评分(NIHSS)评分，安全性结果为症状性脑出血(SICH)、院内脑出血、住院死亡和3个月死亡。结果211例患者中，82例(38.9%)应用替罗非班。服用替罗非班的39例(48.1%)和未服用替罗非班的44例(36.1%)的MRS评分为0~2[调整后的优势比(OR)为2.41；95%可信区间(CI)为1.11~5.23，P=0.026]。替罗非班组在治疗后24小时的NIHSS评分低于对照组(9.5vs.12.0，调整后P=0.032)。5例服用替罗非班的患者(6.1%)和16例未服用替罗非班的患者(12.4%)发生SICH(调整后OR为0.54；95%CI为0.16~1.83，P=0.32)。使用替罗非班的10例(12.2%)和未使用替罗非班的41例(31.8%)发生院内脑出血(调整后OR为0.32；95%CI为0.13~0.76，P=0.01)。使用替罗非班的7例(8.5%)和未使用替罗非班的16例(12.4%)发生住院死亡(调整后OR为0.69；95%CI为0.22~2.13，P=0.52)。服用替罗非班的13例(15.9%)和未服用替罗非班的22例(17.1%)3个月死亡(调整后OR为0.98；95%CI为0.40~2.40，P=0.96)。结论替罗非班联合EVT治疗3个月时MRS评分较低，24 h时NIHSS评分较低，与SICH发生率、住院病死率及3个月内病死率无关。
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.