Effects of Tirofiban on Neurological Deterioration in Patients With Acute Ischemic Stroke

 

Didn't your competent? hospital start using this years ago? Oh, so you don't have a functioning stroke hospital do you? Contact the board of directors and ask them all to resign for incompetence!

• tirofiban (12 posts to November 2012)

Effects of Tirofiban on Neurological Deterioration in Patients With Acute Ischemic Stroke

Wenbo Zhao, MD¹; Sijie Li, MD^1,2,3; Chuanhui Li, MD⁴; et al Chuanjie Wu, MD¹; Junmei Wang, MD⁵; Lifei Xing, MD⁶; Yue Wan, MD⁷; Jinhui Qin, MD⁸; Yaoming Xu, MD^9,10; Ruixian Wang, MD^11,12; Changming Wen, MD¹³; Aihua Wang, MD¹⁴; Lan Liu, PhD¹⁵; Jing Wang, MD¹; Haiqing Song, MD¹; Wuwei Feng, MD¹⁶; Qingfeng Ma, MD¹; Xunming Ji, MD, PhD¹⁷; for the TREND Investigators

Author Affiliations

JAMA Neurol. Published online April 22, 2024. doi:10.1001/jamaneurol.2024.0868

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Abstract

Key Points

Question  Does intravenous tirofiban reduce early neurological deterioration in patients with acute noncardioembolic stroke?

Findings  In this randomized clinical trial including 425 patients, the proportion of patients who experienced neurological deterioration within 72 hours was significantly lower in the tirofiban group compared with the aspirin group. The safety profiles of tirofan and aspirin were similar.

Meaning  Given the safety and efficacy profiles of intravenous tirofiban in patients with acute noncardioembolic stroke, tirofiban could be used as a first-line antiplatelet drug to prevent early neurological deterioration.

Abstract

Importance  Evidence supports using antiplatelet therapy in patients with acute ischemic stroke. However, neurological deterioration remains common under the currently recommended antiplatelet regimen, leading to poor clinical outcomes.

Objective  To determine whether intravenous tirofiban administered within 24 hours of stroke onset prevents early neurological deterioration in patients with acute noncardioembolic stroke compared with oral aspirin.

Design, Setting, and Participants  This investigator-initiated, multicenter, open-label, randomized clinical trial with blinded end-point assessment was conducted at 10 comprehensive stroke centers in China between September 2020 and March 2023. Eligible patients were aged 18 to 80 years with acute noncardioembolic stroke within 24 hours of onset and had a National Institutes of Health Stroke Scale (NIHSS) score of 4 to 20.

Intervention  Patients were assigned randomly (1:1) to receive intravenous tirofiban or oral aspirin for 72 hours using a central, web-based, computer-generated randomization schedule; all patients then received oral aspirin.

Main Outcome  The primary efficacy outcome was early neurological deterioration (increase in NIHSS score ≥4 points) within 72 hours after randomization. The primary safety outcome was symptomatic intracerebral hemorrhage within 72 hours after randomization.

Results  A total of 425 patients were included in the intravenous tirofiban (n = 213) or oral aspirin (n = 212) groups. Median (IQR) age was 64.0 years (56.0-71.0); 124 patients (29.2%) were female, and 301 (70.8%) were male. Early neurological deterioration occurred in 9 patients (4.2%) in the tirofiban group and 28 patients (13.2%) in the aspirin group (adjusted relative risk, 0.32; 95% CI, 0.16-0.65; P = .002). No patients in the tirofiban group experienced intracerebral hemorrhage. At 90-day follow-up, 3 patients (1.3%) in the tirofiban group and 3 (1.5%) in the aspirin group died (adjusted RR, 1.15; 95% CI, 0.27-8.54; P = .63), and the median (IQR) modified Rankin scale scores were 1.0 (0-1.25) and 1.0 (0-2), respectively (adjusted odds ratio, 1.28; 95% CI, 0.90-1.83; P = .17).

Conclusions and Relevance  In patients with noncardioembolic stroke who were seen within 24 hours of symptom onset, tirofiban decreased the risk of early neurological deterioration but did not increase the risk of symptomatic intracerebral hemorrhage or systematic bleeding.

Trial Registration  ClinicalTrials.gov Identifier: NCT04491695

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