Safety and Efficacy of Tirofiban During Mechanical Thrombectomy for Stroke Patients with Preceding Intravenous Thrombolysis
Safety and Efficacy of Tirofiban During Mechanical Thrombectomy for Stroke Patients with Preceding Intravenous Thrombolysis
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DOI：
10.2147/cia.s238769
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发表时间：
2020-01-01
影响因子：
3.6
通讯作者：
Miao, Zhongrong
中科院分区：
文献类型：
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作者：
Huo, Xiaochuan;Yang, Ming;Miao, Zhongrong
目的：替罗非班对急性缺血性脑卒中（AIS）患者行机械取栓（MT）术前静脉溶栓（IVT）治疗是否安全有效尚不清楚。我们的目的是评估替罗非班在术前IVT患者MT期间的安全性和有效性。患者和方法：根据是否使用替罗非班救救性治疗，将接受MT和IVT治疗的患者从ANGEL登记处提取，分为替罗非班组和非替罗非班组。安全终点为局部脑出血、全脑出血和远端栓塞。疗效终点为动脉再通、3个月功能独立性（修正Rankin量表[mRS]: 0-2）和死亡率。结果：我们从整个注册表中纳入了207例既往IVT的MT患者。其中替罗非班组55例，非替罗非班组152例，mt后24小时内发生缺血性脑出血17例（8.2%），发生缺血性脑出血36例（17.4%）；远端血栓栓塞11例（5.3%）；随访3个月后，111例（53.6%）功能独立，34例（16.4%）死亡。在整个队列中，替罗非班组与非替罗非班组在siich、ICH和远端血栓栓塞的安全性、再通和长期功能独立的有效性方面均无显著差异（各组均p < 0.05）。替罗非班与MT及IVT患者长期死亡率降低相关（校正风险比0.28[0.08-0.94]，校正p=0.03）。结论：在接受MT和IVT治疗的AIS患者中，救援替罗非班与siich、ICH或远端血栓栓塞的安全终点风险增加无关，并且可能与较低的长期死亡风险相关。早期替罗非班抗血小板治疗对MT及IVT患者的疗效有待进一步研究。
Purpose: Whether tirofiban is safe and effective for acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) with preceding intravenous thrombolysis (IVT) remains unclear. We aim to evaluate the safety and efficacy of tirofiban during MT for patients with preceding IVT.Patients and Methods: Patients who underwent MT and preceding IVT were derived from the ANGEL registry and were dichotomized into tirofiban and non-tirofiban group according to whether rescue tirofiban was performed. The safety endpoints were sICH, total ICH and distal embolization. The efficacy endpoints were arterial recanalization, three-month functional independence (modified Rankin Scale [mRS]: 0-2) and mortality.Results: We included 207 MT patients with preceding IVT from the entire registry. Among them, there were 55 in tirofiban group and 152 in non-tirofiban group, and 17 (8.2%) patients suffered sICH and 36 (17.4%) suffered ICH within 24 hours post-MT; 11 (5.3%) distal embolization of thrombus; 111 (53.6%) achieved functional independence and 34 (16.4%) died after three-month follow-up. No significant differences in safety outcomes on sICH, ICH and distal embolization of thrombus and efficacy outcomes on recanalization and long-term functional independence were found between tirofiban and non-tirofiban group for the entire cohort (p>0.05 for all groups). Tirofiban was correlated with long-term mortality reduction for patients underwent MT and preceding IVT (adjusted hazard ratio 0.28 [0.08-0.94], adjusted p=0.03).Conclusion: In AIS patients who underwent MT and preceding IVT, rescue tirofiban was not correlated with increased risk of safety endpoints on sICH, ICH or distal embolization of thrombus, and might be associated with a lower risk of long-term mortality. Further study is needed to confirm the effect of early antiplatelet therapy with tirofiban for patients underwent MT and preceding IVT.