Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion

Zi, Wenjie, Song, Jiaxing, Kong, Weilin, Huang, Jiacheng, Guo, Changwei, He, Wencheng, Yu, Yinquan, Zhang, Bo, Geng, Wanjie, Tan, Xiaolin, Tian, Yaoyu, Liu, Zongtao, Cao, Minghua, Cheng, Daoyou, Li, Bo, Huang, Wenguo, Liu, Junsheng, Wang, Pengfei, Yu, Zhou, Liang, Hao, Yang, Shuang, Tang, Mingshan, Liu, Wenhua, Huang, Xianjun, Liu, Shugai, Tang, Yufeng, Wu, Youlin, Yao, Li, Shi, Zhu, He, Pengcheng, Zhao, Haojin, Chen, Zhuo, Luo, Jun, Wan, Yue, Shi, Qiang, Wang, Maorong, Yang, De, Chen, Xianglin, Huang, Fang, Mu, Jinlin, Li, Hao, Li, Zhimin, Zheng, Jingbang, Xie, Shunli, Cai, Tieying, Peng, Yuqi, Xie, Weihua, Qiu, Zhongming, Liu, Chang, Yue, Chengsong, Li, Linyu, Tian, Yan, Yang, Dahong, Miao, Jian, Yang, Jie, Hu, Jinrong, Nogueira, Raul G, Wang, Duolao ORCID: https://orcid.org/0000-0003-2788-2464, Saver, Jeffrey L, Li, Fengli and Yang, Qingwu (2023) 'Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion'. The New England journal of medicine, Vol 388, Issue 22, pp. 2025-2036.

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Abstract

The effects of the glycoprotein IIb/IIIa receptor inhibitor tirofiban in patients with acute ischemic stroke but who have no evidence of complete occlusion of large or medium-sized vessels have not been extensively studied. In a multicenter trial in China, we enrolled patients with ischemic stroke without occlusion of large or medium-sized vessels and with a National Institutes of Health Stroke Scale score of 5 or more and at least one moderately to severely weak limb. Eligible patients had any of four clinical presentations: ineligible for thrombolysis or thrombectomy and within 24 hours after the patient was last known to be well; progression of stroke symptoms 24 to 96 hours after onset; early neurologic deterioration after thrombolysis; or thrombolysis with no improvement at 4 to 24 hours. Patients were assigned to receive intravenous tirofiban (plus oral placebo) or oral aspirin (100 mg per day, plus intravenous placebo) for 2 days; all patients then received oral aspirin until day 90. The primary efficacy end point was an excellent outcome, defined as a score of 0 or 1 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. Secondary end points included functional independence at 90 days and a quality-of-life score. The primary safety end points were death and symptomatic intracranial hemorrhage. A total of 606 patients were assigned to the tirofiban group and 571 to the aspirin group. Most patients had small infarctions that were presumed to be atherosclerotic. The percentage of patients with a score of 0 or 1 on the modified Rankin scale at 90 days was 29.1% with tirofiban and 22.2% with aspirin (adjusted risk ratio, 1.26; 95% confidence interval, 1.04 to 1.53, P = 0.02). Results for secondary end points were generally not consistent with the results of the primary analysis. Mortality was similar in the two groups. The incidence of symptomatic intracranial hemorrhage was 1.0% in the tirofiban group and 0% in the aspirin group. In this trial involving heterogeneous groups of patients with stroke of recent onset or progression of stroke symptoms and nonoccluded large and medium-sized cerebral vessels, intravenous tirofiban was associated with a greater likelihood of an excellent outcome than low-dose aspirin. Incidences of intracranial hemorrhages were low but slightly higher with tirofiban.

Item Type:	Article
Subjects:	QV Pharmacology > QV 4 General works WL Nervous System > WL 300 General works (Include works on brain alone)
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1056/NEJMoa2214299
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	15 Jun 2023 12:02
Last Modified:	15 Jun 2023 12:02
URI:	https://archive.lstmed.ac.uk/id/eprint/22622

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