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Objective:To investigate the efficacy and safety of tirofiban in patients with acute ischemic stroke (AIS) with early neurological deterioration (END).Methods:Consecutive patients with AIS who had END and did not receive reperfusion treatment admitted to Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University within 24 h of onset from January 2017 to December 2022 were retrospectively included. END was defined as an increase of ≥2 in the National Institutes of Health Stroke Scale score within 72 h after onset compared at admission, or an increase of 1 in motor function. The tirofiban group was given tirofiban within 2 h after the occurrence of END, while the control group was given aspirin+clopidogrel. A score of ≤2 on the modified Rankin Scale at 90 d after onset was considered as a good outcome.Results:A total of 502 patients with AIS who had END were enrolled; including 322 males (64.14%) aged 65 ± 9 years. There was no statistically significant difference in baseline characteristics between the tirofiban group ( n=252) and the control group ( n=250). The good outcome rate of the tirofiban group at 90 d was significantly higher than that of the control group (60.32% vs. 42.00%; P<0.05), while there were no statistically significant differences in the incidence of symptomatic hemorrhagic transformation, asymptomatic hemorrhagic transformation, death and serious adverse events within 90 d. There were statistically significant differences in diabetes, atrial fibrillation, use of tirofiban, and the classification of stroke etiology between the good outcome group and the poor outcome group ( P<0.05). Multivariate logistic regression analysis showed that the use of tirofiban was an independent correlated factor for good outcome (odds ratio 0.33, 95% confidence interval 0.22-0.48; P<0.001). Conclusion:Tirofiban has good efficacy and safety for END in patients with AIS who did not received reperfusion therapy.
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Objective To observe the inhibitory effect of Tirofiban on different shear-induced platelet aggregation, and to provide medication suggestions for the treatment of thrombosis in different hemodynamic environment. Methods Polydimethylsiloxane ( PDMS)-glass microchannel chips were fabricated by soft lithography. The whole blood of healthy volunteers anticoagulated with sodium citrate was collected and incubated with different concentrations of Tirofiban in vitro. The blood flowed through the straight microchannel or channel with 80% narrow for 150 seconds at the speed of 11 μL/ min and 52 μL/ min, respectively. The wall shear stress rates in straight channel at 11 μL/ min and 52 μL/ min were 300 s-1 and 1 500 s-1, respectively. The maximum wall shear rates in the channel with 80% occlusion at 11 μL/ min and 52 μL/ min were 1 600 s-1 and 7 500 s-1, respectively. The adhesion and aggregation images of fluorescent labeled platelets on glass surface were photographed with the microscope, and the fluorescent images were analyzed with Image J. The platelet surface coverage ratio was used as a quantitative index of platelet aggregation behavior, and the IC50 of Tirofiban for platelet inhibition was calculated under different shear rates. Flow cytometry was used to detect the platelet activation index (CD62P, PAC-1) in the whole blood at 52 μL/ min in channel with 80% occlusion. Results Tirofiban inhibited platelet aggregation in a dose-dependent manner, and the inhibitory effect was related to the shear rate. Under the shear rates of 11 μL/ min and 52 μL/ min, the aggregation was almost completely inhibited when the concentration in straight channel reached 100 nmol / L. When the concentration in channels with 80% occlusion reached 1 μmol / L, the aggregation was almost completely inhibited. IC50 values at 11 μL/ min and 52 μL/ min in straight channel were 2. 3 nmol / L and 0. 5 nmol / L, respectively. IC50 values at 11 μL/ min and 52 μL/ min in channels with 80% occlusion were 20. 73 nmol / L and 4. 5 nmol / L. Pathologically high shearforce induced an increase in platelet activation, which could be inhibited by Tirofiban. Conclusions Tirofiban can effectively inhibit shear-induced platelet aggregation, and different concentrations of Tirofiban should be given according to the thrombus formed in different shear force environment in clinic practice
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Objective:To investigate the safety of tirofiban in patients with anterior circulation acute large vessel occlusion cerebral infarction during bridging endovascular treatment (EVT) after intravenous thrombolysis (IVT).Methods:Two hundred and three patients received bridging EVT after IVT in Department of Intervention, First Affiliated Hospital of Soochow University from January 2017 to January 2022 were chosen. Patients were divided into tirofiban group ( n=80) and non-tirofiban group ( n=123) according to whether or not tirofiban was used during EVT, and then patients from tirofiban group were subdivided into stent implantation group ( n=52) and non-stent implantation group ( n=28) according to whether or not emergency stent implantation was performed. The clinical data, safety indexes (intracranial hemorrhage [ICH] rate 24 h, 2-3 d, and 90 d after EVT, new ICH incidence 3-90 d after EVT, fatal ICH rate, and mortality 90 d after EVT), and prognoses 90 d after EVT were compared. Results:(1) Compared with the non-tirofiban group, the tirofiban group had significantly higher proportions of males, and patients with tandem occlusion, balloon dilation or stent implantation, and statistically lower proportion of patients with atrial fibrillation, significantly longer surgical time, and significantly different distribution of stroke types ( P<0.05). No significant differences were noted in ICH incidences 24 h after EVT, 2-3 d after EVT and 90 d after EVT, fatal ICH incidence, mortality incidence 90 d after EVT, or good prognosis rate 90 d after surgery between tirofiban group and non-tirofiban group ( P>0.05). (2) Patients in the stent implantation group had significantly higher percentages of tandem occlusion and balloon dilation compared with those in the non-stent implantation group ( P<0.05). No significant difference was noted in good prognosis rate 90 d after EVT or new ICH incidence 3-90 d after EVT between the stent implantation group and the non-stent implantation group ( P>0.05). Compared with the non-stent implantation group, the stent implantation group had statistically higher ICH incidences 24 h after EVT, 2-3 d after EVT, and 90 d after EVT, significantly higher fatal ICH incidence and mortality 90 d after EVT ( P<0.05). Conclusion:Tirofiban is safe in patients with anterior circulation acute large vessel occlusion cerebral infarction during EVT after IVT; however, if emergency stent implantation is performed, it will lead to increased intracranial hemorrhage and mortality.
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Objective:To evaluate the safety and efficacy of intravenous tirofiban in stent-assisted embolization of acute ruptured intracranial aneurysms.Methods:A total of 286 patients with acute ruptured intracranial aneurysms who received stent-assisted embolization in Department of Neurosurgery, Linyi People's Hospital from January 2020 to September 2022 were enrolled. According to different preoperative antiplatelet regiments, they were divided into aspirin combined with double resistant group (preoperatively taking orally loading dose of aspirin and clopidogrel, n=167) and tirofiban group (intravenously injecting tirofiban, n=119). Propensity score matching (PSM) was used to adjust for potential differences in age, gender, Hunt-Hess grading, hypertension history, diabetes history, smoking history, aneurysm location, aneurysm neck, aneurysm body-neck ratio, and stent types; incidences of perioperative hemorrhagic and ischemic complications, and neurological recovery status at discharge (scores of modified Rankin scale [mRS]≤2 as good recovery) were compared between the two groups. Results:After 1:1 PSM, 96 patients were included in each group. No significant difference in incidence of hemorrhagic complications was noted between the double resistant group (2.1%) and tirofiban group (0.0%, P>0.05). No significant difference in incidence of ischemic complications was noted between the double resistant group (9.3%, including 8 with intraoperative thrombosis and 1 with postoperative infarction) and tirofiban group (7.2%, including 6 with intraoperative thrombosis and 1 with postoperative infarction, P>0.05). No significant difference in good recovery rate at discharge was noted between double resistant group (86.4%) and tirofiban group (90.6%, P>0.05). Conclusion:In stent-assisted embolization therapy for acute ruptured intracranial aneurysms, preoperative intravenous tirofiban enjoys the same safety and efficacy compared with preoperative oral loading dose of aspirin and clopidogrel.
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【Objective】 To investigate the clinical manifestations, diagnosis, differential diagnosis and management strategies of thrombocytopenia caused by tirofiban. 【Methods】 The basic clinical data, platelet count changes and treatment course of 7 patients with acute coronary syndrome who used tirofiban resulting in severe thrombocytopenia during their hospitalization in our hospital from December 2021 to March 2023 were collected, and their individual and common characteristics were analyzed. 【Results】 Platelet counts were in the normal range in all 7 patients on admission. Six of the patients had thrombocytopenia occurring from 3 to 16 hours after tirofiban use, and one patient was detected at 34 h of tirofiban use. Their minimum platelet count ranged from (1-11)×109/L. All 7 cases discontinued tirofiban and other antithrombotic drugs, and the platelet count increased to 50×109/L in 6 patients in 2 to 4 days after stopping the drug and gradually returned to the normal range. During this period, there were no bleeding or acute thrombotic events, and no platelet transfusion was conducted. Five patients resumed antithrombotic therapy when the platelet count returned to (20-50)×109/L, 1 patient underwent elective coronary artery bypass grafting (CABG) surgery when the count rose above 50×109/L. One patient had bleeding manifestations after thrombocytopenia and required limited-duration CABG surgery, so 3 U platelet transfusion and immunoglobulin treatment were performed consecutively. CABG surgery was performed when the platelet count increased to 76×109/L. The differential diagnosis of the cause of thrombocytopenia was performed in all seven patients, and other causes of thrombocytopenia, such as heparin, were excluded. 【Conclusion】 Tirofiban can cause acute severe or extremely severe thrombocytopenia. Routine platelet count testing at 6 hours after medication can prevent serious adverse events by discontinuing tirofiban promptly after thrombocytopenia occurs. At the same time, it is determined whether to perform platelet transfusion based on whether the patient has bleeding and the risk of bleeding, and the timing of resuming antithrombotic treatment is determined based on the recovery of platelet count and the risk of thrombosis.
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Objective:To investigate the efficacy of dapagliflozin combined with tirofiban in patients with type 2 diabetes mellitus complicated with coronary heart disease.Methods:A total of 120 patients with type 2 diabetes mellitus and coronary heart disease treated in Fuyang People′s Hospital from January to August 2022 were prospectively selected as subjects. According to different treatment methods, they were divided into control group and experimental group. The control group was treated with tirofiban, and the experimental group was treated with dapagliflozin combined with tirofiban. The efficacy and safety of treatments between the two groups were compared.Results:After 3 months of treatment, fasting plasma glucose (FPG), 2 h postprandional blood glucose (2 h PG), glycated hemoglobin (HbA 1c), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), D-dimer (D-D) and fibrinogen (FIB) levels in 2 groups were decreased compared with before treatment:experimental group: (7.33 ± 1.77) mmol/L vs. (9.45 ± 2.05) mmol/L, (10.33 ± 2.07) mmol/L vs. (13.57 ± 2.88) mmol/L, (7.22 ± 1.28) % vs. (9.25 ± 1.78) %, (1.98 ± 0.29) mmol/L vs. (6.05 ± 1.24) mmol/L, (2.95 ± 0.37) mmol/L vs. (4.35 ± 0.76) mmol/L, (0.78 ± 0.23) mg/L vs. (1.85 ± 0.79) mg/L, (2.57 ± 0.37) g/L vs. (7.15 ± 1.36) g/L, control group: (8.21 ± 1.85) mmol/L vs. (9.68 ± 2.17) mmol/L, (11.78 ± 2.26) mmol/L vs. (13.89 ± 3.02) mmol/L, (8.25 ± 1.36) % vs. (9.37 ± 1.86) %, (2.77 ± 0.42) mmol/L vs. (6.08 ± 1.22) mmol/L, (3.84 ± 0.44) mmol/L vs. (4.27 ± 0.72) mmol/L, (1.34 ± 0.52) mg/L vs. (1.81 ± 0.72) mg/L, (5.25 ± 0.84 ) g/L vs. (7.11 ± 1.28) g/L, the differences were statistically significant ( P< 0.05). The levels of FPG, 2 h PG, HbA 1c, TC, LDL-C, D-D and FIB between the two groups were statistically significant ( P<0.05). High density lipoprotein cholesterol (HDL-C) level, left ventricular ejection fraction (LVEF), cardiac blood transfusion volume (CO), stroke output (SV), thrombin time (TT) and partially activated prothrombin time (APTT) were all increased: experimental group: (1.76 ± 0.30) mmol/L vs. (1.07 ± 0.28) mmol/L, (68.64 ± 12.91) % vs. (45.05 ± 12.24) %, (4.88 ± 0.91) L/min vs. (3.95 ± 1.12) L/min, (53.66 ± 5.43) ml/min vs. (43.27 ± 4.88) ml/min, (31.83 ± 4.39) s vs. (23.25 ± 3.44) s, (13.85 ± 2.17) s vs. (10.75 ± 1.56) s, control group: (1.43 ± 0.26) mmol/L vs. (1.06 ± 0.24) mmol/L, (60.37 ± 11.86) % vs. (45.42 ± 12.41) %, (4.37 ± 0.84) L/min vs. (4.17 ± 1.16) L/min, (47.86 ± 5.27) ml/min vs. (43.36 ± 4.94) ml/min, (27.24 ± 3.91) s vs. (23.78 ± 3.62) s, (12.74 ± 1.94) s vs. (10.89 ± 1.78) s, the differences were statistically significant ( P<0.05). There were significant differences in HDL-C, LVEF, CO, SV, TT and APTT between the two groups ( P<0.05). The incidence of adverse reactions in experimental group was lower than that in control group during treatment: 5.00% (3/60) vs. 16.67% (10/60), and the difference was statistically significant ( P<0.05). Conclusions:Dapagliflozin combined with tirofiban in the treatment of patients with type 2 diabetes mellitus complicated with coronary heart disease has obvious curative effect, and can improve blood glucose and blood lipid levels, coagulation function and cardiac function, with high safety.
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@#Objective To investigate the efficacy and safety of early application of tirofiban after intravenous thrombolysis in patients with branch atheromatous disease.Methods We retrospectively analyzed data collected from patients with BAD who were admitted to our hospital from March 2017 to July 2021.Subjects were classified into the alteplase-only control group and the alteplase+tirofiban treatment group.A propensity score matching analysis was performed to control substantial heterogeneity of subgroup.We compared the incidence of early neurological deterioration end,the rapeutic effect and bleeding risk between the two groups.Results The incidence of early neurological deterioration was lower in the tirofiban treatment group than in the control group on day 1 (P<0.05).NHISS score were higher on day 1 and day 7 in the tirofiban treatment group as compared to the control group (P<0.05).MRS score on 90 days were higher in the tirofiban treatment group as compared to the control group (P<0.05).When compared to the control group,the proportion of patients with a favorable outcome (mRS,0~1 point) three months after stroke was greater in the tirofiban therapy group.The proportion of patients with dependence (mRS≥4 points) was lower in the tirofiban treatment group than in the control group.There was no case of intracranial hemorrhage in either group.Conclusion Early adding low-dose tirofiban after intravenous thrombolysis could reduce early neurological deterioration and improve the long-term prognosis of patients with branch atheromatous disease.
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Objective:To evaluate the safety and efficacy of intra-arterial tirofiban infusion during endovascular reperfusion therapy in patients with acute cardiogenic cerebral embolism.Methods:Clinical data of 72 patients with acute cardiogenic cerebral embolism caused by large artery occlusion were retrospectively analyzed in Department of Neurology, Strategic Support Force Medical Center from August 2015 to August 2020.Among those, 52 patients were treated with intra-arterial tirofiban, the other 20 patients were treated with control medication. The baseline characteristics, modified thrombolysis in cerebral infarction (mTICI) score of responsible vessels, modified Rankin scale (mRS) score 90 days after operation, incidence of symptomatic intracranial hemorrhage and mortality were evaluated and compared in two groups.Results:The proportion of effective recanalization of the offending vessels (mTICI≥2b) in tirofiban group was higher than that in control group (92.3% vs. 75.0%), but the difference was not statistically significant ( P=0.104). At 90 days after operation, the rate of patients with good prognosis (mRS≤2) in tirofiban group (61.5%) was significantly higher than that in control group (35.0%) ( P<0.05). The incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups ( P>0.05). Conclusion:Intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism is effective and feasible, which improves the prognosis without increasing the risk of intracranial bleeding complications.
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【Objective】 To explore the feasibility of tirofiban, a platelet surface glycoprotein (GP)Ⅱb/Ⅲa receptor antagonist intervene in transfusion-related acute lung injury (TRALI), by inhibiting platelet activation and by preventing platelet and neutrophil binding to form aggregates. 【Methods】 1) Fifty wild-type male Balb/c mice, aged 8 to 10 weeks, were randomly divided into TRALI, normal, tirofiban TRALI intervention, isotype control and tirofiban normal intervention groups. In the TRALI model, tirofiban TRALI intervention and isotype control groups, each mouse was injected intraperitoneally with lipopolysaccharide (LPS) 0.1 mg/kg, and after 18 h with 4.5 mg/kg anti-MHC-I or IgG2a isotype control antibody, in which 0.5 μg/g tirofiban was injected 30 min before anti-MHC-I injection, and was labeled as tirofiban TRALI intervention. The group without any treatment was set as normal group. The tirofiban normal intervention group was injected with only 0.5 μg/g tirofiban into the tail vein, 30 min before the injection of anti-MHC-I. 2) After antibody injection, the mice were observed for 2 h, then executed with their lungs removed, and the extent of lung injury and the intervention effect of tirofiban were analyzed by comparing the differences in lung dry to wet ratio, total protein, myeloperoxidase (MPO), inflammatory factors and quantitative results of HE staining. The platelet activation level in whole blood and immunofluorescence (IF) quantification of platelet and neutrophil fluorescence were detected by flow cytometry to analyze the mechanism of tirofiban on TRALI. 【Results】 1) The indexes of lung injury in the tirofiban TRALI intervention group and TRALI model group for HE staining were 0.663 3±0.141 9 vs. 0.173 3±0.120 4 (P<0.05), respectively; 2) Platelet activation levels(%)in whole blood in the TRALI group, normal group and tirofiban TRALI intervention group were 22.87±9.943 vs 5.070±2.234 vs 5.767±3.224(P<0.05), respectively. 3) The mean fluorescence density of platelet neutrophil aggregates for IF detection in the tirofiban intervention group and TRALI model group was 21.89±3.536 vs. 32.77±0.9624 (P<0.05). 【Conclusion】 The platelet GP Ⅱ b/Ⅲa-specific inhibitor tirofiban inhibited platelet-neutrophil binding in mice, thus could possibly intervene in TRALI.
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Objective:To investigate the efficacy and safety of sequential treatment with tirofiban and argatroban in acute isolated pontine infarction (AIPI) caused by branch atheromatous disease (BAD).Methods:Consecutive patients with AIPI caused by BAD within 48 h of onset and admitted to Zhengzhou Central Hospital from April 2021 to April 2022 were enrolled retrospectively. The patients were divided into sequential treatment group and tirofiban group according to their therapeutic modalities. In the tirofiban group, tirofiban was pumped intravenously within 48 h after admission, and dual antiplatelet therapy with aspirin and clopidogrel was added 4 h before tirofiban was discontinued. On the basis of tirofiban treatment, the sequential treatment group was followed by argatroban for 5 days when tirofiban is discontinued. The main outcome measure was the modified Rankin Scale (mRS) score at 3 months after the onset . A score of <2 was defined as a good outcome. The secondary outcome measure was all the adverse events during the treatment and follow-up. Multivariate logistic regression analysis was used to determine the independent factors of the outcomes. Results:A total of 64 patients with AIPI caused by BAD were enrolled, including 32 in the sequential treatment group and 32 in the tirofiban group. There was no statistical difference in baseline data between the two groups, but the rate of good outcomes at 3 months after onset in the sequential treatment group was significantly higher than that in the tirofiban group (78.1% vs. 50.0%; χ2=5.497, P=0.019). Multivariate logistic regression analysis showed that after adjusting for low-density lipoprotein cholesterol, the higher baseline National Institutes of Health Stroke Scale score was independently associated with the poor outcomes (odds ratio 2.067, 95% confidence interval 1.343-3.182; P=0.001), while the sequential treatment was independently associated with the good outcomes (odds ratio 0.248, 95% confidence interval 0.064-0.957; P=0.043). Conclusion:Early application of sequential treatment with tirofiban and argatroban in AIPI caused by BAD may effectively improve the outcomes of patients, and the safety is good.
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Objective:To investigate the efficacy and safety of intravenous tirofiban after endovascular therapy in patients with acute intracranial large atherosclerotic stroke.Methods:Patients with acute intracranial large atherosclerotic stroke received endovascular therapy in the Stroke Center, Nanjing Drum Tower Hospital from January 2018 to December 2020 were enrolled. The incidence of symptomatic intracranial hemorrhage in patients of tirofiban group and non-tirofiban group during perioperative period and the outcome after procedure at 90 d were analyzed.Results:A total of 172 patients were included. Their average age was 66.0 years and 126 patients were male (73.3%). Ninety-two patients (53.5%) used tirofiban, and 120 (69.8%) had good outcomes. Compared with the non-tirofiban group, the tirofiban group had a significantly higher rate of good outcome at 90 d after procedure (77.2% vs. 61.3%; P=0.023). The reocclusion rate was significantly lower (7.6% vs. 18.8%; P=0.039), while there was no statistically significant difference in the incidence of symptomatic intracranial hemorrhage during periprocedureal period (4.3% vs. 3.8%; P=0.990). There was a significant independent correlation between the use of tirofiban intravenously and the good outcome at 90 d after procedure, both in the overall patients (odds ratio 0.208, 95% confidence interval 0.064-0.680; P=0.009) and the patients with severe stroke (odds ratio 0.181, 95% confidence interval 0.050-0.658; P=0.009) were all the same. Conclusion:For patients with acute intracranial large atherosclerotic stroke who received intravascular therapy, intravenous tirofiban can significantly improve the clinical outcome at 90 d after procedure, and will not increase the risk of symptomatic intracranial hemorrhage.
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Objective:To investigate the clinical safety and efficacy of tirofiban in the treatment of hemiplegic stroke warning syndrome.Methods:Patients with hemiplegic stroke warning syndrome admitted to Jining First People's Hospital without receiving intravenous thrombolysis from January 2018 to May 2020 were enrolled retrospectively. Some patients were given tirofiban intravenous infusion for at least 24 h in acute phase, then received oral antiplatelet therapy (tirofiban group); some only received aspirin+ clopidogrel dual antiplatelet therapy (control group). The primary endpoint was muscle strength at the paralytic side and National Institutes of Health Stroke Scale (NIHSS) score at day 7 after onset. The secondary endpoint was the modified Rankin Scale (mRS) score at 3 months after onset, and ≤2 was defined as good clinical outcome. The safety endpoint was the bleeding events during treatment. Multivariate logistic regression analysis was used to determine the independent influencing factors of clinical outcome. Results:A total of 30 patients with hemiplegic stroke warning syndrome were enrolled, including 19 (63.3%) in the tirofiban group and 11 (36.7%) in the control group. There was no significant difference in baseline clinical data between the two groups, and no drug-related bleeding complications occurred during treatment. The muscle strength at paralytic side and NIHSS score at day 7 after onset, NIHSS score at discharge and good clinical outcome rate at 3 months in the tirofiban group were significantly better than those in the control group, and the differences were statistically significant (all P<0.05). Multivariate logistic regression analysis showed that tirofiban was an independent protective factor for good outcome after adjusting the NIHSS score at the beginning of treatment (odds ratio 0.040, 95% confidence interval 0.040-0.449; P=0.009). Conclusions:Tirofiban is safe and effective in the treatment of patients with hemiplegic stroke warning syndrome in acute phase. It can effectively block the progress of the disease, improve the outcome of patients, and will not increase the risk of bleeding.
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Objective:To analyze the clinical effect of TREVO stent thrombectomy combined with tirofiban on patients with acute large-artery occlusion of the anterior circulation.Methods:Seventy-two patients with acute large-artery occlusion of the anterior circulation accepted thrombectomy in our hospital from November 2016 to May 2020 were divided into two groups according to different treatment methods: 35 patients in the control group were treated with TREVO stent thrombectomy, and 37 patients in the treatment group were treated with TREVO stent thrombectomy combined with tirofiban via intra-variceal injection. The success rate of recanalization, specific conditions of thrombolysis, improvement degrees of nerve defect, coagulation function, prognoses 90 d after thrombectomy, and complications were compared between the two groups.Results:The success rate of postoperative vascular recanalization in the treatment group and control group was 91.89% (34/37) and 88.57% (31/35), respectively, without statistically significant difference ( P>0.05). The time and times of thrombotomy in the treatment group were significantly shorter/smaller than those in the control group (P<0.05). The National Institute of Health stroke scale (NIHSS) scores of patients from the treatment group 14 d after thrombectomy were significantly lower than those of the control group ( P<0.05). The postoperative thrombin time, prothrombin time, and activated partial thrombin time of the treatment group were significantly longer than those of the control group ( P<0.05). The good prognosis rate of patients in the treatment group and control group 90 d after thrombectomy was 86.49% (32/37) and 60.0% (21/35), with significant differences ( P<0.05); and the incidence of complications was 8.11% (3/37) and 14.29% (5/35), without significant differences ( P>0.05). Conclusion:TREVO stent thrombectomy combined with tirofiban has a significant effect on treatment of acute large-artery occlusion of the anterior circulation, enjoying high safety.
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Objective:To explore the effectiveness and safety of tirofiban in patients with reocclusive ischemic stroke after intravenous thrombolysis with alteplase.Methods:Eighty-four patients with re-occlusive ischemic stroke after intravenous thrombolysis with alteplase, admitted to our hospital from January 2018 to May 2020, were prospectively chosen; these patients were divided into tirofiban group and routine (non-tirofiban) group ( n=42). In addition to thrombolysis, patients in the routine group received intensive lipid-lowering, collateral circulation improvement, blood glucose control, and early rehabilitation therapy; after thrombolysis for 24 h, patients without intracranial hemorrhage were given oral aspirin, 0.1 g/d, for 90 d. After thrombolysis and re-occlusion, patients in the tirofiban group were intravenously pumped with 0.4 μg/(kg·min), which was changed to 0.1 μg/(kg·min) after 30 min for 24 h; at 24 h after thrombolysis, brain CT was reexamined: tirofiban was discontinued for patients with intracranial hemorrhage, and intravenous pumping of tirofiban was continued for patients without intracranial hemorrhage for 24 h. Effectiveness was evaluated by comparing the general clinical data, National Institutes of Health Stroke Scale (NIHSS) scores 7 d after treatment, and modified Rankin Scale (mRS) scores 90 d after treatment between the two groups. Safety was assessed by comparing the intracranial hemorrhage, symptomatic intracranial hemorrhage, and mortality within 90 d of treatment between the two groups. Results:There were no significant differences in age, gender, underlying diseases, risk factors, baseline NIHSS scores, time from onset to start of treatment, infarction sites, and TOAST classification between the 2 groups ( P>0.05). NIHSS scores 7 d after treatment ([10.05±4.73] min vs. [7.93±4.68] min), mRS scores 90 d after treatment (3.48±1.48 vs.2.55±1.93), and good prognosis rate 90 d after treatment (21.4% vs. 42.9%) showed significant differences between the routine group and tirofiban group ( P<0.05). In terms of safety, there were no significant differences in intracranial hemorrhage rate (4.76% vs. 7.14%), symptomatic intracranial hemorrhage incidence (2.38% vs. 2.38%) and mortality (2.38% vs. 2.38%) between the 2 groups ( P>0.05). Conclusion:It is safe and effective for tirofiban in patients with re-occlusive ischemic stroke after intravenous thrombolysis with alteplase.
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@#Objective To investigate the efficacy of tirofiban on transient ischemic attack with high risk of recurrence.Methods 156 patients with non-cardiogenic transient ischemic attack with ABCD2 score ≥ 4 points were hospitalized at the Department of Neurology,Sinopharm Tongmei General Hospital from Jan 2019 to Mar 2021.Eight patients were excluded due to incomplete data or drop-off from follow-up.The remaining 148 patients were randomly divided into two groups,78 in the observation group and 70 in the control group.The observation group was given tirofiban treatment (loading tirofiban via a micropump,and continuous intravenous pumping for 48 hours) and intensive lipid-lowering therapy.The control group was given intensive anti-platelet aggregation therapy with Aspirin enteric-coated tablets,hydroclopidogre and intensive lipid-lowering therapy.We made a comparative analysis between two groups about efficacy,safety and short-term stroke incidence.Results In the observation group,57 cases were cured,14 cases were effective,and 7 cases were ineffective;6 cases (7.69%) had a stroke (cerebral infarction) within 7 days,7 cases (8.97%) had a stroke within 30 days,and 7 cases (8.97%) had a stroke within 90 days.In the control group,39 cases were markedly effective,15 cases were effective,and 16 cases were ineffective;in the control group,13 cases (18.57%) had a stroke (cerebral infarction) within 7 days,15 cases (21.43%) had a stroke within 30 days,16 cases (22.86%) had a stroke within 90 days.No intracerebral hemorrhage occurred in either group within 90 days.The two groups had statistical significance in terms of effective treatment rate (P<0.05).However,there was no significant difference in the number of stroke cases between the observation group and the control group in the short-term 7 days,30 days,and 90 days (P>0.05).There was no significant difference in coagulation,platelet,liver and kidney function between the two groups after 48 hours of treatment (P>0.05).Conclusion For patients with transient ischemic attack at high risk of recurrence,tirofiban treatment can effectively control TIA attacks,but it cannot reduce the risk of stroke.
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OBJECTIVES: To investigate the safety and efficacy of combined tirofiban-ozagrel therapy for treating progressive stroke patients out of thrombolytic therapy time window. METHODS: This prospective, double-blind, randomized controlled study included 337 patients who had experienced an acute ischemic stroke between November 2017 and December 2018. All patients were randomized into three groups: 1) the tirofiban/ozagrel group (n=113), 2) the tirofiban group (n=110), and 3) the ozagrel group (n=114). The platelet aggregation (PAG), thrombin time (TT), prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen (FIB) levels in the patients from these groups were evaluated before starting treatment and then, at 24h, 7 days, and 14 days after treatment. The National Institutes of Health Stroke Scale (NIHSS) scores were evaluated before treatment and then, 24h, 1 week, 2 weeks, and 4 weeks after treatment. The Barthel Index (BI) score was used to measure safety, and the modified Rankin scale (mRS) was used to evaluate disability following 3 months of treatment. The risk factors affecting clinical outcomes were analyzed using logistic multivariate regression. RESULTS: The mean NIHSS score for all the patients was 13.17±3.13 before treatment, and no significant difference between the basic clinical parameters of the three patient groups was found. Following treatment, both PAG and FIB were significantly reduced compared with the baseline (p<0.05). The levels of PAG and FIB in the tirofiban/ozagrel group were significantly lower than those in the tirofiban and ozagrel groups at 24h and 7 days after treatment (p<0.05). The NIHSS score decreased significantly in all treatment groups (p<0.05). The tirofiban/ozagrel NIHSS scores were significantly lower than that of the tirofiban and ozagrel groups at 24h, 1 week, and 2 weeks post initiation (p<0.05 for all). There were no significant differences in the BI and mRS scores or the intracranial hemorrhage rates; further, age, sex, Trial of ORG 10172 in acute stroke treatment (TOAST) type, baseline NIHSS and 24-h NIHSS scores, baseline thrombus-related factors, and treatment methods were shown to not be independent risk factors for clinical outcomes. CONCLUSION: The combination of tirofiban and ozagrel, as well as monotherapy with either tirofiban or ozagrel, transiently improves the neural function of patients and reduces platelet aggregation and fibrinogen formation in the first 4 weeks following a stroke event; additionally, none of these treatments increased the risk for hemorrhage in these progressive stroke patients over a 3-month period.
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Humanos , Isquemia Encefálica/tratamiento farmacológico , Accidente Cerebrovascular/tratamiento farmacológico , Terapia Trombolítica , Infarto Cerebral/tratamiento farmacológico , Método Doble Ciego , Estudios Prospectivos , Resultado del Tratamiento , Tirofibán/uso terapéutico , MetacrilatosRESUMEN
Resumo A ponte de tirofiban é uma alternativa à suspensão da terapia antiplaquetária dupla no perioperatório de pacientes com alto risco de trombose de stent e de sangramento. Objetivamos avaliar a eficácia e a segurança deste protocolo em pacientes submetidos à cirurgia em até 12 meses após intervenção coronária percutânea com stent. Realizamos uma revisão sistemática por meio de pesquisa nas bases PubMed, Web of Science, Cochrane, EMBASE, LILACS e SciELO e nas referências de artigos relevantes ao tema. Dos 107 trabalhos encontrados, cinco foram incluídos após análise dos critérios de elegibilidade e da qualidade metodológica, totalizando 422 pacientes, sendo 227 do grupo controle. Apesar das limitações reportadas, quatro dos cinco estudos incluídos indicam que a ponte de tirofiban é eficaz em reduzir eventos cardíacos adversos e segura ao não interferir no risco de eventos hemorrágicos ou sangramentos. Todavia, são necessários ensaios clínicos randomizados para evidências robustas.
Abstract Use of a tirofiban bridge is an alternative to simply withdrawing dual antiplatelet therapy prior to operating on patients at high risk of stent thrombosis and bleeding. We aimed to evaluate the efficacy and safety of this protocol in patients undergoing surgery within 12 months of a percutaneous coronary intervention involving stenting. We performed a systematic review based on searches of the PubMed, Web of Science, Cochrane, Embase, Lilacs, and Scielo databases and of the references of relevant articles on the topic. Five of the 107 studies identified were included after application of eligibility criteria and analysis of methodological quality, totaling 422 patients, 227 in control groups. Notwithstanding the limitations reported, four of the five studies included indicate that the tirofiban bridge technique is effective for reducing adverse cardiac events and is safe in terms of not interfering with the risk of hemorrhagic events or bleeding. However, randomized clinical trials are needed to provide robust evidence.
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Stents , Periodo Perioperatorio/efectos adversos , Tirofibán/uso terapéutico , Terapia Antiplaquetaria Doble , Complicaciones Posoperatorias/prevención & control , Inhibidores de Agregación Plaquetaria/uso terapéuticoRESUMEN
SUMMARY This study aimed to develop and validate a stability-indicating liquid chromatography method for the determination of tirofiban hydrochloride and two synthetic impurities (impurity A and impurity C). The method utilizes a RP-18 column (250 mm x 4.6 mm; 5 µm) with the PDA detector for quantitation. A mixture of triethylamine 0.1% (acidified to pH 5.5 with phosphoric acid) and acetonitrile was used as the mobile phase at a flow rate of 1 mL min-1 with gradient elution. The method presented satisfactory linearity, precision, accuracy and robustness, as well as low limits of detection and quantification, which demonstrate sensitivity in the determination of tirofiban and impurities A and C. It was selective for the determination of the drug and impurities analysed, without interference of the degradation products generated under forced conditions, demonstrating the stability-indicating capacity of the proposed method. Tirofiban showed to be practically stable to oxidative (30% H2O2 for 24 h) and thermal (75 °C for 24 h) conditions, but presented degradation to UVA light and acid hydrolysis, obeying the first order kinetics for both. In this way, it can be used as a stability-indicating method in the quality control of the raw material of tirofiban hydrochloride, as well as of the finished product. The obtained results demonstrate the importance of deepening the studies in this area, to guarantee the quality of commercialized pharmaceutical products.
RESUMO Este estudo teve como objetivo desenvolver e validar método indicativo da estabilidade por cromatografía líquida para determinação de cloridrato de tirofibana e duas impurezas de síntese (impureza A e impureza C). O método utilizou coluna de fase reversa RP-18 (250 mm x 4,6 mm; 5 µm) e detector PDA para quantificação. A fase móvel foi composta por uma mistura de trietilamina 0,1% (acidificada com ácido fosfórico para pH 5,5) e acetonitrila, à vazão de 1 mL/min, no modo gradiente. O método apresentou linearidade, precisão, exatidão, robustez, bem como baixos limites de detecção e quantificação, demonstrando sensibilidade na determinação da tirofibana e impurezas A e C. O método apresentou seletividade na determinação do fármaco e das impurezas, sem interferência dos produtos de degradação gerados na degradação forçada da tirofibana, demonstrando sua capacidade indicativa de estabilidade. O fármaco apresentou-se estável a oxidação (H2O2 30% por 24 h) e a degradação térmica (75 °C por 24 h), mas degradou frente à luz UVA e hidrolise ácida, obedecendo cinética de primeira ordem para ambas. Dessa forma, pode ser utilizado como um método indicativo de estabilidade no controle de qualidade da matéria -prima do cloridrato de tirofibana, bem como no produto acabado. Os resultados obtidos demonstram a importância de aprofundar os estudos na área, com intuito de garantir a qualidade dos produtos farmacêuticos comercializados.
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OBJECTIVE：To evaluate the benefit and risk of tirofiban in the treatment of acute coronary syndrome （ACS），and to provide evidence-based reference for clinical drug selection and decision. METHODS ：Retrieved from domestic and foreign database as PubMed ，the Cochrane Library ，CNKI and Wanfang database ，during the establishment of database to Apr. 2020，two researcher independently screened the literature based on inclusion and exclusion criteria and extracted the data. After the quality evaluation of the included literatures ，based on rapid health technology assessment ，the extracted results were classifiedly evaluated and comprehensively analyzed. RESULTS ：A total of 13 researches of systematic review/Meta-analysis and 1 research of pharmacoeconomics were included. Compared with placebo ，tirofiban could significantly reduce all-cause mortality [OR ＝0.68， 95％CI（0.54，0.86），P＝0.000 1] and the incidence of major adverse cardiac events （MACE）in patients with ACS [RR ＝0.24， 95％CI（0.14，0.40），P＜0.01]，and increased the incidence of TIMI 3 [OR＝5.73，95％CI（2.99.10.97），P＜0.01]. Tirofiban and eptifibatide had similar therapeutic efficacy in the treatment of ACS ，but tirofiban significantly increased the risk of TIMI small bleeding in patients with ACS [RR ＝0.61，95％CI（0.38，0.98），P＝0.04]. For ACS patients with non-ST elevation （NSTE-ACS）， compared with placbo ，tirofiban significantly reduced the incidence of MACE [RR ＝0.76，95％ CI（0.61，0.96），P＝0.018]，but significantly increased the risk of bleeding [OR ＝1.49，95％CI（1.12，1.98），P＝0.006]，while there was no significant difference in its effects on the all-cause mortality of NSTE-ACS patients （P＞0.05）. For STEMI patients ，compared with placebo ，tirofiban significantly reduced the all-cause mortality [RR＝0.61，95％CI（0.35，1.05），P＝0.007] and the incidence of MACE [RR ＝0.63，95％ CI（0.44，0.90），P＝0.007]. When combined with liposuction ，tirofiban also significantly reduced the incidence of MACE [RR ＝ 2.05，95％CI（1.71，2.46），P＜0.01]，and significantly increased the incidence of TIMI 3 [OR＝3.18，95％ CI（2.4，4.22），P＜ 0.01]，but there was no significant difference in its effects on bleeding risk （P＞0.05）. The included pharmacoeconomic study showed that patients treated with bivalutine could get 10.07 QALYs，patients treated with heparin combined with tirofiban could get 9.98 QALYs，and the incremental cost-effectiveness ratio bivalutine compared to the latter one was 28 575.77 yuan/QALYs，which was lower than 3 times of the per capita GDP of some cities. CONCLUSIONS ：Tirofiban has good efficacy in the treatment of ACS，but it can increase the risk of bleeding than eptifibatide and placebo. Domestic bivalirudin treating for ACS has a cost-effectiveness advantage over tirofiban combined with heparin.
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Objective:To investigate the safety and efficacy of tirofiban therapy in acute cerebral infarction patients having broadened therapeutic time window.Methods:Eighty-four acute cerebral infarction patients having broadened therapeutic time window (the onset time was within 4.5-8 h), admitted to our hospital from January 2016 to May 2018, were chosen in our study. Forty-two patients (treatment group), with the informed consent of himself or his family, received emergent cerebral angiography and treated with tirofiban (the load of tirofiban was pumped via the microductal artery, and the maintenance load was continuously pumped intravenously for 48 h) right after the angiography; the other 42 patients (control group) received emergent cerebral angiography and treated with intensive antiplatelet aggregation therapy right after the angiography; intensive lipid-lowering therapy was given in both groups. The efficacy, safety and follow-up rehabilitation were compared between the two groups. According to the locations of acute cerebral infarction, patients in the treatment group were divided into anterior circulation infarction subgroup ( n=24) and posterior circulation infarction subgroup ( n=18); the efficacy and follow-up rehabilitation were compared between the two subgroups. Results:Patients from the treatment group had significantly lower National Institutes of Health Stroke Scale (NIHSS) scores 48 h, 7 d, and 10 d after treatment, and significantly higher NIHSS score difference values before and after treatment than those from control group ( P<0.05); the proportion of patents having good prognosis (modified Rankin scale [mRS] scores≤2) in the treatment group 3 months after treatment (78.57%) was significantly higher than that in the control group (52.38%), and the Barthel index in the treatment group 3 months after treatment (94.76±11.67) was significantly higher than that in the control group (85.00±15.17, P<0.05). Patients from the posterior circulation infarction subgroup had significantly lower NIHSS scores 48 h, 7 d, and 10 d after treatment, and significantly higher NIHSS score difference values before and after treatment than those from anterior circulation infarction subgroup ( P<0.05); the proportion of patents having good prognosis in the posterior circulation infarction subgroup 3 months after treatment (94.44%) was significantly higher than that in the anterior circulation infarction subgroup (66.67%, P< 0.05). There were no statistically significant differences in platelet count and coagulation tests between the treatment group and control group, and between the posterior circulation infarction subgroup and anterior circulation infarction subgroup ( P>0.05). Conclusion:Tirofiban could improve the prognoses of patients with acute cerebral infarction in broadened therapeutic time window, enjoying high effectiveness and safety, which are more obvious in the posterior circulation infarction.