Effect Of Tirofiban On Hemorrhagic Transformation After Endovascular Therapy In Patients With Acute Cerebral Infarct

Aims:The safety of GP Ⅱb/ⅢⅡa receptor antagonist tirofiban is still controversial in patients with acute cerebral infarct receiving endovascular treatment,especially for those who received intravenous thrombolysi s bridging endovascular treatment.Therefore,the aim of this study was to investigate the effect of tirofiban on the hemorrhagic transformation and prognosis in patients with acute cerebral infarct receiving endovascular treatment.Methods:This retrospective study included patients with acute cerebral infarct who received endovascular stent mechanical thrombectomy and divided them into tirofiban treatment and control groups between October 2013 and April 2017.Hemorrhagic transformation was assessed for each patient using the ECASS Ⅱcriteria.Unfavorable outcome was defined as modified Rankin score(mRS)≥3.Binary logistic regression model was used to analyze the independent predictors of hemorrhagic transformation and neurological outcome.Results:A total of 115 acute cerebral infarct patients(male,n=70 and female,n=47;mean age,66.9±12.6 years)had complete clinical data,with 32 cases in the tirofiban group and 85 cases in the control group.The onset to puncture(OPT)time was(317±125)min.The pretreatment NIHSS was 15(IQR,11～18).Multivariate logistic regression analysis showed that tirofiban treatment did not increase the risk of hemorrhagic transformation(OR=0.440,95%CI=0.178～1.087,P=0.075).Baseline platelet count(OR=0.993,95%CI=0.987～1.0000,P=0.043)and history of hypertension(OR=2.399,95%CI=0.987～1.0000,P=0.047)were independently associated with hemorrhagic transformation after treatment.Additionally,baseline NIHSS(OR=0.853,95%CI=0.747～0.974,P=0.019),recanalization(OR=15.961,95%CI=2.538～100.386,P=0.003),history of hypertension(OR=0.263,95%CI=0.079～0.875,P=0.029)and OPT(OR=0.994,95%CI=0.989～0.999,P=0.026),but not tirofiban treatment(OR=0.514,95%CI=0.151～1.747,P=0.286)were independently associated with unfavorable outcome.Conclusion:The use of tirofiban in patients with acute ischemic stroke does not increase the risk of hemorrhagic transformation,indicating that tirofiban appears to be safe for patients with acute cerebral infarct receiving endovascular therapy.