Association between tirofiban administration and sex in outcomes following endovascular treatment for large vessel occlusion stroke

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• tirofiban (15 posts to November 2012)

Association between tirofiban administration and sex in outcomes following endovascular treatment for large vessel occlusion stroke

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  Sheng Zhou 1†

• Y

  Yongjiao Dai 1†

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  Lingyu Zhang 2†

• H

  Haoxuan Zhu 3,4†

• L

  Lilan Wang 3

• R

  Rugang Luo 1

• L

  Li Yang 1

• L

  Li Jing 1

• X

• Y

• J

• T

• G

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  Mingrui Zhou 6‡ *

• 1. Department of Neurology, Renhuai People's Hospital, Zunyi, Guizhou, China

• 2. Department of Neurology, Lanzhou University Second Hospital, Lanzhou, China

Abstract

Background: 

Intravenous tirofiban administered before endovascular treatment (EVT) did not improve 90-day outcomes compared to placebo in the RESCUE BT trial, and sex-specific heterogeneity remained uncertain. In this study, we aimed to evaluate the association between sex and tirofiban administration before EVT among patients enrolled in the RESCUE BT trial.

Materials and methods: 

This post hoc analysis used data from the RESCUE BT trial, which enrolled 948 patients with large vessel occlusion (LVO). Patients received intravenous tirofiban or a placebo before EVT. Comparisons between different groups were conducted using logistic regression. Additionally, the interaction between sex and treatment was tested. The primary effectiveness outcome was a modified Rankin Scale (mRS) score of 0–2 at 90 days; safety outcomes included symptomatic intracranial hemorrhage (sICH) within 48 h and mortality at 90 days.

Results: 

Of the 948 patients, 391 (41.2%) were women. The interaction between sex and treatment for a 90-day mRS score of 0–2 was not statistically significant (P for interaction = 0.103). However, in the tirofiban arm, women were less likely to achieve an mRS score of 0–2 at 90 days (adjusted odds ratio (aOR), 0.57; 95% confidence interval (CI), 0.36–0.90; p = 0.02) compared to men. In analyses stratified by sex, tirofiban was not associated with improved functional outcomes compared to placebo in either women or men. No sex-related differences were observed in symptomatic intracranial hemorrhage within 48 h or mortality at 90 days.

Conclusion: 

In this exploratory analysis, no significant interaction between sex and treatment was identified, indicating that the association between tirofiban and 90-day outcomes did not differ by sex. Although women in the tirofiban arm had lower odds of achieving an mRS score of 0–2 at 90 days than men, this finding should be interpreted as hypothesis-generating and warrants further validation.