Intravenous Tirofiban Following Endovascular Therapy for Patients with Acute Large Vessel Occlusion Stroke

医学 替罗非班 改良兰金量表 冲程(发动机) 优势比 内科学 队列 单变量分析 逻辑回归 倾向得分匹配 心脏病学 外科 多元分析 心肌梗塞 缺血性中风 缺血 经皮冠状动脉介入治疗 机械工程 工程类
作者
Lina Zheng,Yaqi Liu,Ximing Nie,Hongyi Yan,Weibin Gu,Xin Liu,Wanying Duan,Zhe Zhang,Jingyi Liu,Yufei Wei,Miaowen Wen,Zhonghua Yang,Yuesong Pan,Xinyi Leng,Zhongrong Miao,Liping Liu
出处
期刊:International Journal of Stroke [SAGE Publishing]
标识
DOI:10.1177/17474930251386577
摘要

Background: The role of intravenous (IV) tirofiban administered following endovascular therapy (EVT) for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) remains uncertain. Aims: To investigate the associations of IV tirofiban following EVT with clinical outcomes in patients with acute LVO stroke and to determine whether the associations differ between anterior-circulation stroke (ACS) and posterior-circulation stroke (PCS). Methods In this prospective, national, multicenter registry, patients with AIS due to intracranial LVO who underwent EVT within 24 hours of onset were enrolled, and categorized into IV tirofiban and no-IV tirofiban groups. The primary outcome was functional independence at 90 days, defined as a modified Rankin Scale of 0-2. Secondary outcomes included the distribution of 90-day mRS, independent ambulation, symptomatic intracranial hemorrhage (sICH), early neurological deterioration (END) and 90-day mortality. Analyses included univariate and multivariable logistic regression, propensity score matching (PSM, 1:1 ratio). Results Among 1,836 eligible patients (1,342 ACS; 494 PCS), 362 (19.7%) received IV tirofiban following EVT. After PSM, 720, 498 and 196 patients were included in the entire, ACS and PCS cohort, respectively. In the ACS cohort, IV tirofiban was associated with higher odds of functional independence (57.0% vs 43.8%; adjusted odds ratio [aOR] 1.55, 95% CI 1.08–2.22; P=0.02) and a favorable shift in 90-day mRS. In the entire cohort, the association was attenuated after adjustment (aOR 1.33, 95% CI 0.99–1.79; P=0.06). In the PCS cohorts, IV tirofiban was associated with numerically higher functional independence (31.6% vs. 18.4%), but without statistical significance (aOR 1.54, 95% CI 0.74–3.17; P=0.25). No significant differences were found in sICH, END, or 90-day mortality between groups across all cohorts. Conclusion IV tirofiban administration following EVT was associated with improved favorable functional outcomes in AIS patients with anterior-circulation LVO, without increasing the risk of sICH or END, but no significant association was observed in PCS patients. Further randomized controlled trials are warranted to verify these findings.

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