Effect Of Tirofiban On New Cerebral Microbleeds In Patients With Acute Ischemic Stroke

BACKGROUND AND OBJECTIVE Patients with acute ischemic stroke(AIS)could emerge new cerebral microbleeds(CMBs).DWI-ASPECTS(Alberta stroke program early CT score on diffusion-weighted imaging)<6 points is a risk factor for new CMBs in patients with ischemic stroke and CMBs are risk factors for intracranial hemorrhage.Intravenous antiplatelet drug tirofiban does not increase intracranial hemorrhage in patients with acute ischemic stroke,but whether it will increase new CMBs in patients with acute ischemic stroke has not been reported.In this study,we aimed to explore the possibility of tirofiban increasing risks of emerging cerebral microbleeds(CMBs)in patients with AIS.METHODS Patients with AIS admitted from March 2014 to July 2017 were enrolled prospectively.One or more of the following treatments were given depending on the patient's condition:intravenous thrombolysis,endovascular therapy,antiplatelet(aspirin/clopidogrel or aspirin plus clopidogrel),anticoagulation(low molecular weight heparin/warfarin),statins,fluid supplements and symptomatic treatment.Based on these treatments,some patients were given intravenous tirofiban according to their condition.The use of tirofiban was 8 mL intravenous injection,and then continuous intravenous injection(civ)8 mL/h for 24 h.According to whether tirofiban was used,the patients were divided into intervention group(using tirofiban)and control group(tirofiban was not used).Patients with middle cerebral artery infarction and DWI-ASPECTS?6 points were allocated into intervention and control subgroups.Susceptibility weighted imaging(SWI)were completed within 48 h after admission and performed again in 10 to 14 d after onset to detect CMBs.New CMBs were compared between two groups.RESULTS A total of 118 patients with AIS were enrolled,including 36 cases of intervention(tirofiban)group and 82 cases of control group,with 26 cases of intervention subgroup and 38 cases of control subgroup.The demographic data(age and sex),associated vascular risk factors(hypertension,hyperlipidemia,diabetes,past stroke or transient ischemic attack history,history of smoking and drinking),physical examination(systolic blood pressure,diastolic blood pressure),laboratory examination(total cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol,fasting blood glucose,glycosylated hemoglobin,serum creatinine),neither between intervention and control group nor between two subgroups had significant difference(P>0.05).Compared with control group,significantly fewer atrial fibrillation(5.6%vs 23.3%,P<0.05),less cardiogenic cerebral embolism(5.6%vs 25.6%P<0.05),lower proportion of mono antiplatelet(5.6%vs 63.4%,P<0.01)and anticoagulant(0%vs 18.3%,P<0.01)therapy,lower NIHSS scores(10.9±4.4vs 13.7±5.0,P<0.05)and less new CMBs(11.2%vs 30.5%,,P<0.05)were observed in intervention group.However,higher DWI-ASPECTS in middle cerebral infarction patients(7.0± 1.4 vs 5.9+2.5,P<0.05)and more small-artery occlusion lacunar(22.2%vs 7.3%,P<0.05)and dual antiplatelet therapy(94.4%vs 19.5%,P<0.01)were documented in the intervention group.In addition,of all the patients with acute middle cerebral artery infarction as well as DWI-ASPECTS>6,there were no difference in DWI-ASPECTS or new CMBs.Oral antiplatelet intensity was greater(P<0.01),while the anticoagulation ratio was lower(P<0.05)in intervention subgroup.CONCLUSION Patients with AIS would emerge new CMBs,and tirofiban might not significantly increase the risk of new CMBs in AIS patients.A large randomized controlled trial will be needed in the future to further investigate the effects of tirofiban on long-term prognosis in AIS patients.