Safety and Efficacy of Tirofiban Combined With Mechanical Thrombectomy Depend on Ischemic Stroke Etiology
Safety and Efficacy of Tirofiban Combined With Mechanical Thrombectomy Depend on Ischemic Stroke Etiology
复制标题
替罗非班联合机械取栓术的安全性和有效性取决于缺血性卒中病因
DOI：
10.3389/fneur.2019.01100
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发表时间：
2019-10-29
影响因子：
3.4
通讯作者：
Zou, Jianjun
中科院分区：
文献类型：
--
作者：
Sun, Chao;Li, Xiang;Zou, Jianjun
背景和目的：替罗非班在接受机械血栓切除术（MT）的急性缺血性卒中（AIS）患者中的临床应用仍存在争议。我们的目的是评估替罗非班联合MT治疗AIS患者的安全性和有效性。方法：2014年1月至2018年12月接受MT的AIS患者入组中国的三个卒中单元。根据ORG 10172急性卒中治疗试验（吐司）标准分类的卒中病因进行亚组分析。安全性结局为3个月时的院内脑出血（ICH）、症状性脑出血（sICH）和死亡率。疗效结局为3个月时的良好功能结局和功能独立性，以及24 h、3 d和出院时的神经功能改善。结果如下：在大动脉粥样硬化（LAA）卒中患者中，多变量分析显示替罗非班显著降低了院内ICH的几率（校正OR = 0.382，95% CI 0.180-0.809），并倾向于增加3个月时良好功能结局的几率（校正OR = 3.050，95% CI 0.969-9.598）。相比之下，在心源性栓塞（CE）卒中患者中，替罗非班与3个月时良好功能结局的可能性无关（校正OR = 0.719，95% CI 0.107-4.807），但24 h和3 d时神经功能改善的几率显著降低（校正OR = 0.185，95%CI 0.047-0.726;校正OR = 0.268，95%CI 0.087-0.825）。结论：替罗非班联合MT治疗LAA安全有效，但对CE患者无明显疗效。
Background and Purpose: The clinical use of tirofiban for patients with acute ischemic stroke (AIS) who underwent mechanical thrombectomy (MT) remains controversial. We aimed to evaluate the safety and efficacy of tirofiban combined with MT in AIS patients. Methods: Patients with AIS who underwent MT from January 2014 to December 2018 were enrolled in three stroke units in China. Subgroup analyses were performed based on stroke etiology which was classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. Safety outcomes were in-hospital intracerebral hemorrhage (ICH), symptomatic intracerebral hemorrhage (sICH) and mortality at 3-month. Efficacy outcomes were favorable functional outcome and functional independence at 3-month and neurological improvement at 24 h, 3 d and discharge. Results: In patients with large artery atherosclerosis (LAA) stroke, multivariate analyses revealed that tirofiban significantly decreased the odds of in-hospital ICH (adjusted OR = 0.382, 95% CI 0.180–0.809) and tended to increase the odds of favorable functional outcome at 3-month (adjusted OR = 3.050, 95% CI 0.969–9.598). By contrast, in patients with cardioembolism (CE) stroke, tirofiban was not associated with higher odds of favorable functional outcome at 3-month (adjusted OR = 0.719, 95% CI 0.107–4.807), but significantly decreased the odds of neurological improvement at 24 h and 3d (adjusted OR = 0.185, 95% CI 0.047–0.726; adjusted OR = 0.268, 95% CI 0.087–0.825). Conclusions: Tirofiban combined with MT appears to be safe and effective in LAA patients, but has no beneficial effect on CE patients.