Safety of bridging antiplatelet therapy with the gpIIb-IIIa inhibitor tirofiban after emergency stenting in stroke.
Safety of bridging antiplatelet therapy with the gpIIb-IIIa inhibitor tirofiban after emergency stenting in stroke.
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DOI：
10.1371/journal.pone.0190218
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Jander S
中科院分区：
文献类型：
--
作者：
Lee JI;Gliem M;Gerdes G;Turowski B;Kaschner M;Kraus B;Hartung HP;Jander S
在一定比例的急性大血管闭塞卒中患者中，永久性支架植入是实现成功再通的必要条件。这种紧急支架植入术后的最佳血小板抑制策略尚不清楚。因此，我们分析了急性卒中患者急诊支架置入术后早期糖蛋白（gp） IIb/IIIa抑制剂治疗的结果。我们从2010年12月至2014年6月在卒中单位登记中确定了60例急诊支架置入术患者，并对其进行回顾性分析。所有患者在急性手术后立即静脉注射gpIIb/IIIa拮抗剂替罗非班，直到改用口服阿司匹林和氯吡格雷。为了比较，我们在倾向评分调整分析中研究了135例M1闭塞患者，他们接受了取栓术，没有支架植入或替罗非班治疗。急性支架置入组出现并发症，住院期间死亡6例（10%），再梗死2例（3%），脑出血12例（20%），症状性脑出血5例（8%）。37例（62%）患者在90天后达到中度mRS 0-3。在不给替罗非班的取栓组中，住院期间死亡率、脑出血率和第90天的转归无差异。在我们的回顾性研究中，急性支架植入后gpIIb/IIIa抑制与脑出血或院内死亡风险增加无关。
In a proportion of stroke patients with acute large vessel occlusion permanent stent implantation is mandatory to achieve successful recanalization. The optimum platelet inhibition strategy after such emergency stenting is unknown. We therefore analyzed the outcome of early glycoprotein (gp) IIb/IIIa inhibitor treatment after emergency stenting in acute stroke. Sixty patients with emergency stenting were identified in our stroke unit registry from 12/2010-06/2014 and analyzed retrospectively. All patients were bridged intravenously with the gpIIb/IIIa antagonist tirofiban immediately after the acute procedure until switching to oral aspirin and clopidogrel was performed. For comparison we studied 135 patients with M1 occlusion undergoing thrombectomy without stent implantation or tirofiban treatment in a propensity score-adjusted analysis. In the acute stenting group receiving tirofiban complications with 6 deaths during the hospital stay (10%), 2 reinfarctions (3%), 12 intracerebral hemorrhages (ICH; 20%) and 5 symptomatic ICH (8%) occurred. Thirty-seven patients (62%) reached a moderate outcome of mRS 0–3 after 90 days. In the thrombectomy group without tirofiban administration the rate of deaths within hospital stay, the rate of ICH and outcome at day 90 were not different. In our retrospective study acute stenting with subsequent gpIIb/IIIa inhibition was not associated with an increased risk of ICH or in-hospital death.
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