| Purpose:Capsular warning sydrome(CWS)is a special type of transient cerebral ischemic attack,which can easily lead to permanent neurological impairment.Currently,some centers have explored the application of tirofiban in the treatment of CWS,but few clinical reports have been reported.In this study,the efficacy and prognosis of tirofiban combined with oral antiplatelet drugs(aspirin and clopidogrel)and oral antiplatelet drugs alone in the treatment of CWS patients in our center were retrospectively compared to explore the safety and efficacy of tirofiban in the treatment of CWS patients.Methods:Patients who met the diagnostic criteria of CWS in our hospital from January 2017 to November 2018 were retrospectively collected,and were divided into two groups according to whether they were treated with tirofiban or not: tirofiban group and dual antibody group.For team had given for class with oral antiplatelet drug therapy,had double anti treatment group given oral antiplatelet drugs(aspirin and clopidogrel)treatment,two groups of hospitalization in progress for irreversible nerve function defect(nerve function defect symptom duration of 1 h or higher)in thrombolysis in patients with indications,beyond a taboo signed written informed consent and patient or family member to give thrombolysis treatment.The main endpoint events were: 1.Recurrent or progressive irreversible neurological impairment at 24 h,7 days and 3 months;2.Occurrence of adverse events such as intracranial hemorrhage,systemic hemorrhage and death.Secondary end points were the National Institutes of Health Stroke Scale(NIHSS)score after thrombolysis and the prognosis of patients 3 months later(a modified Rankin Scale score of 0 at 3 months was defined as a good prognosis).SPSS 23.0 software was used for data analysis.The two groups were compared by ?2-test,t-test,mann-whitney U test,etc.End event evaluation results were analyzed by ?2-test,t-test and Fisher exact test,P < 0.05 was statistically significant.Results:A total of 34 patients were included,including 16 patients in the tirofiban group and 18 patients in the double-antibody treatment group.1.In tirofiban group,the number of patients with recurrence or progression of irreversible neurological impairment within 24 h was significantly lower than that in the double-antibody group(3vs10,P=0.03).Patients in the tirofiban group who had a recurrence or progression of irreversible neurological impairment within 7 days were significantly less than those in the double-antibody group(3 vs 11,P=0.01).Patients in the tirofiban group who experienced recurrence or progression of irreversible neurological impairment within 3 months after treatment were significantly less than those in the double-antibody group(5 vs12,P=0.04).2.There was no statistical difference in the incidence of adverse events such as intracranial hemorrhage,systemic hemorrhage and death between the two groups(P > 0.05).3.Among the patients in the two groups receiving thrombolytic therapy during hospitalization,the NIHSS score of patients in the tirofiban group after thrombolytic therapy was lower than that in the double-antibody treatment group(0.33±0.58)vs(1.48±0.66),and the difference between the two groups was not statistically significant(P=0.16).4.Patients with good prognosis in the tirofiban group were more than those in the double-antibody treatment group,and the difference between the two groups was not statistically significant(p=0.20).Conclusion:1.Compared with oral antiplatelet drugs alone,tirofiban combined with oral antiplatelet drugs can reduce the risk of recurrence and progression of irreversible neurological impairment in CWS patients.2.Compared with oral antiplatelet drugs alone,tirofiban combined with oral antiplatelet drugs did not increase the risk of bleeding in CWS patients.3.For CWS patients with irreversible neurological impairment due to ineffective antiplatelet therapy,tirofiban does not increase the risk of bleeding in patients with thrombolytic therapy. |
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