Low-Dose Tirofiban Improves Functional Outcome in Acute Ischemic Stroke Patients Treated With Endovascular Thrombectomy
Low-Dose Tirofiban Improves Functional Outcome in Acute Ischemic Stroke Patients Treated With Endovascular Thrombectomy
复制标题
低剂量替罗非班可改善接受血管内血栓切除术治疗的急性缺血性中风患者的功能结果
DOI：
10.1161/strokeaha.117.019193
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发表时间：
2017-12-01
期刊：
影响因子：
8.3
通讯作者：
Ji, Xunming
中科院分区：
文献类型：
--
作者：
Zhao, Wenbo;Che, Ruiwen;Ji, Xunming
背景与目的：中国患者大多因大动脉粥样硬化而非心脏栓塞而发生急性缺血性卒中（AIS），替罗非班在这些接受血管内取栓（ET）治疗的患者中是否安全有效尚不清楚。本研究评估了替罗非班在接受et治疗的中国AIS患者中的安全性和有效性。方法：本观察性研究基于单中心前瞻性注册研究。2013年1月至2017年2月期间，使用第二代支架置换器接受ET治疗的AIS患者分别接受单独ET或ET加小剂量替罗非班治疗。主要结局为症状性脑出血（siich）。次要结局包括早期再闭塞率、任何脑出血、致死性脑出血、3个月和长期功能结局。结果：180例AIS患者纳入分析，其中90例接受替罗非班治疗，90例未接受替罗非班治疗。63例(35%)有脑出血，19例(11%)为重度脑出血，9例(5%)为致死性脑出血。替罗非班治疗组10例（11%）发生sICH，未给予替罗非班治疗组9例（10%）发生sICH，差异无统计学意义（P=0.808）。90例接受替罗非班治疗的患者中有4例（4.4%）发生早期牙合，90例未接受替罗非班治疗的患者中有8例（8.9%）发生早期牙合（P=0.370）。161名受试者（89%）完成了长期随访，与未接受替罗非班治疗的患者相比，接受替罗非班治疗的患者死亡几率较低（23%对44%，P=0.005）。此外，替罗非班与较好的长期功能独立性相关（调整优势比为4.37；95%可信区间为1.13-16.97；P=0.033）。结论：在接受ET治疗的AIS患者中，替罗非班与较高的sICH无关，它似乎导致较低的死亡几率和较好的长期功能独立几率。需要进一步的研究来确定替罗非班在预防早期牙合的有效性、潜在的机制和最佳的治疗方案。
Background and Purpose-Chinese patients largely experience acute ischemic stroke (AIS) because of large artery atherosclerosis rather than cardioembolism, and whether tirofiban is safe and effective in these patients treated with endovascular thrombectomy (ET) is unknown. This study evaluated the safety and efficacy of tirofiban in Chinese patients with AIS treated with ET.Methods-This observational study is based on a single-center prospective registry study. Patients with AIS undergoing ET with second-generation stent retrievers from January 2013 to February 2017 were treated with ET alone or ET plus low dose of tirofiban. The primary outcome was symptomatic intracerebral hemorrhage (sICH). The secondary outcomes included rate of early reocclusion, any ICH, fatal ICH, and 3-month and long-term functional outcomes.Results-One hundred eighty AIS subjects were included in the analysis, including 90 subjects treated with tirofiban and 90 subjects without tirofiban. Sixty-three subjects (35%) had any ICH, 19 of them (11%) were sICH, and 9 of them (5%) were fatal ICH. Ten subjects (11%) treated with tirofiban experienced sICH and 9 subjects (10%) not given tirofiban experienced sICH, not a significant difference (P=0.808). Early reocclusion happened in 4 of 90 subjects (4.4%) treated with tirofiban and 8 of 90 subjects (8.9%) not treated with tirofiban (P=0.370). One hundred sixty-one subjects (89%) completed long-term follow-up, subjects treated tirofiban were associated with lower odds of death (23% versus 44%, P=0.005) when compared with those who were not treated. Additionally, tirofiban was associated with better odds of long-term functional independence (adjusted odds ratio, 4.37; 95% confidence interval, 1.13-16.97; P=0.033).Conclusions-In patients with AIS undergoing ET, tirofiban is not associated with higher sICH, it seems to lead to lower odds of deaths and better odds of long-term functional independence. Further investigations are needed to determine the efficacy of tirofiban in preventing early reocclusion, the underlying mechanisms, and its optimal treatment protocol.