Association between intravenous tirofiban and intracranial hemorrhage in acute large vessel occlusion stroke: insight from the RESCUE BT randomized placebo-controlled trial

被引：4

作者：

Sang, Hongfei ^{[1
]}

Huang, Jiacheng ^{[2
]}

Jiang, Bingwu ^{[3
]}

Guo, Qifeng ^{[3
]}

Nguyen, Thanh N. ^{[4
,5
]}

Abdalkader, Mohamad ^{[5
]}

Han, Qin ^{[3
]}

Zhou, Simin ^{[3
]}

Tao, Zhaojun ^{[6
]}

Mao, An ^{[3
]}

Yan, Zhizhong ^{[7
]}

Du, Jie ^{[8
]}

Jin, Ying ^{[9
]}

Huang, Chuming ^{[10
]}

Liu, Tianzhu ^{[11
]}

Zhao, Wenlong ^{[12
]}

Gu, Gangfeng ^{[13
]}

Wang, Li ^{[14
]}

Liu, Shugai ^{[15
]}

Luo, Shiwei ^{[16
]}

Pu, Jie ^{[17
]}

Hu, Jinrong ^{[2
]}

Yang, Jie ^{[2
]}

Li, Fengli ^{[2
]}

Zi, Wenjie ^{[2
]}

Hu, Xiaogang ^{[18
]}

Qiu, Zhongming ^{[2
,3
]}

机构：

[1] Zhejiang Univ Sch Med, Affiliated Hangzhou Peoples Hosp 1, Dept Neurol, Hangzhou 310000, Peoples R China

[2] Army Med Univ, Mil Med Univ 3, Xinqiao Hosp, Affiliated Hosp 2, 183 Xinqiao Main St, Chongqing 400037, Peoples R China

[3] 903rd Hosp Chinese Peoples Liberat Army, Dept Neurol, 14 Lingyin Rd, Hangzhou 310007, Peoples R China

[4] Boston Med Ctr, Dept Neurol, 725 Albany St,Neurol 7Th Floor, Boston, MA 02118 USA

[5] Boston Med Ctr, Dept Radiol, FGH Bldg,4th Floor,820 Harrison Ave, Boston, MA 02118 USA

[6] 903rd Hosp Chinese Peoples Liberat Army, Dept Med Engn, Hangzhou 310007, Peoples R China

[7] 904th Hosp Peoples Liberat Army, Dept Neurosurg, Wuxi 214000, Peoples R China

[8] Kaizhou Dist Peoples Hosp, Dept Neurol, Chongqing 405400, Peoples R China

[9] Songyuan Jilin Oilfield Hosp, Dept Neurol, Songyuan 138000, Peoples R China

[10] Shantou Cent Hosp, Dept Neurol, Shantou 515000, Peoples R China

[11] Affiliated Hosp Tradit Chinese Med Southwest Med U, Dept Neurol, Luzhou 646000, Peoples R China

[12] First Affiliated Hosp Fujian Med Univ, Dept Neurol, Fuzhou 350000, Peoples R China

[13] Yaan Peoples Hosp, Dept Neurol, Yaan 625000, Peoples R China

[14] Third Peoples Hosp Zigong, Dept Neurol, Zigong 643000, Peoples R China

[15] Guangyuan Cent Hosp, Dept Cerebrovascular Dis, Guangyuan 628000, Peoples R China

[16] Jieyang Peoples Hosp, Dept Neurol, Jieyang 522000, Peoples R China

[17] Hubei Prov Hosp Tradit Chinese Med, Dept Neurol, Wuhan 430000, Peoples R China

[18] 904th Hosp Peoples Liberat Army, Dept Mil Patient Management, Wuxi 214000, Peoples R China

来源：

JOURNAL OF NEUROLOGY | 2023年 / 270卷 / 04期

基金：

中国国家自然科学基金;

关键词：

Acute ischemic stroke; Large vessel occlusion; Tirofiban; Endovascular treatment; Adverse event; Intracranial hemorrhage; ACUTE ISCHEMIC-STROKE; ENDOVASCULAR THROMBECTOMY; DOUBLE-BLIND; THERAPY; METAANALYSIS; ANGIOPLASTY; MULTICENTER; RISK;

D O I：

10.1007/s00415-023-11579-4

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BackgroundThe aim of this study is to investigate the association between intravenous tirofiban and symptomatic intracranial hemorrhage (SICH) in patients with acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO) receiving endovascular thrombectomy (EVT) within 24 h of time last known well (LKW). MethodsPatients with AIS-LVO who were randomly assigned to receive intravenous tirofiban or placebo before EVT within 24 h of time LKW and had follow-up brain non-contrast computed tomography within 24 h after stopping tirofiban treatment were derived from "RESCUE BT ": a multicenter, randomized, placebo-controlled, double-blind trial. All eligible patients were divided into SICH and NO-SICH groups. Subgroup analyses were performed to explore for heterogeneity. ResultsOf 945 patients included in this cohort, there were 76 (8.0%) in the SICH group and 869 (92.0%) in the NO-SICH group. The incidence of SICH was not higher in patients receiving intravenous tirofiban compared with placebo (adjusted risk ratio (RR), 1.51; 95% confidence interval (CI), 0.97-2.36; P = 0.07). Subgroup analyses showed that age greater than 67-year-old (adjusted RR, 2.18; 95% CI 1.18-4.00), NIHSS greater than 16 (adjusted RR, 1.88; 95% CI 1.06-3.34), and cardioembolism (adjusted RR, 3.73; 95% CI 1.66-8.35) were associated with increased SICH risk. ConclusionsIn patients with acute large vessel occlusion stroke, intravenous tirofiban before EVT within 24 h of time from last known well is not associated with increased risk of SICH. Patients who are older, have more severe neurological deficits, or with cardioembolism are at higher risk of SICH with intravenous tirofiban.

引用

页码：2246 / 2255

页数：10

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