Safety And Efficacy Of Tirofiban In Patients With Early Neurological Deterioration Following Intravenous Thrombolysis Therapy

Objective: To investigate the safety and efficacy of tirofiban therapy in patients of AIS who have END within the first 24 hours after intravenous thrombolysis.Methods: Patients of AIS with early neurological deterioration who received intravenous thrombolysis therapy in the Department of Neurology,Guizhou Provincial People’s Hospital from November 2018 to October 2020 were analyzed.Patients were immediately received tirofiban hydrochloride for 24 to 72 hours after cerebral hemorrhage was excluded according to reexamination of head CT.Patients with early neurological deterioration who received conventional treatment after intravenous thrombolysis in our hospital from January 2017 to October 2020 were collected as the control group by propensity score matching.General clinical data of patients in both groups were collected,and National Institute of Health stroke scale(NIHSS)was evaluated before intravenous thrombolysis,at END,3d,7d and 14d.Patients were followed up for 3 months,and the Modified Rankin Scale(m RS)was evaluated by outpatient visits or telephone follow-up.Mortality and the incidence of adverse events such as hemorrhagic transformation,systemic bleeding and thrombocytopenia were recorded.For subgroup analysis,patients were divided into mild group,moderate group and severe group according to NIHSS score at admission.Patients were divided into mild END group and severe END group according to change of NIHSS score at END.Patients were divided into large-artery atherosclerosis(LAA)and small-artery occlusion(SAO)group according to TOAST criteria.Patients were divided into anterior circulation stroke(ACS)and posterior circulation stroke(PCS)group according to the infarction area.Results: 1.There was no significant difference between tirofiban group and control group in baseline conditions(P > 0.05).There was no significant difference in NIHSS scores between the two groups at 3d and 7d(P > 0.05).The decreasing of NIHSS scores in tirofiban group was higher than in control group at 14d(P < 0.05).The proportion of patients with better functional outcome at 3 months in tirofiban group was higher than that in control group(78.6% vs 63.3%,P>0.05),The adverse reactions were no significant difference between two groups(P > 0.05).2.For subgroup analysis,there was no significant difference in baseline conditions,adverse reaction and mortality(P>0.05).(1)There was no significant difference in NIHSS scores among the mild,moderate,severe groups at 3d,7d,14d(P>0.05).The proportion of patients with better functional outcome at 3 months in all 3 groups were no significant difference(85.7% vs 75.0% vs 77.8%,P>0.05).(2)There was no significant difference in NIHSS scores between mild END and severe END groups at 3d,7d,14d.There was no significant difference in the proportion of patients with better functional outcome at 3 months between the two groups(80.9% vs71.4%,P>0.05).(3)NIHSS scores of SAO group was lower than LAA group at 3d,7d,14d,but the difference was not significant difference(P>0.05).The proportion of patients with better functional outcome at 3 months in SAO group is higher than LAA group(86.7% vs 69.2%,P > 0.05).(4)There was no significant difference in NIHSS score between the ACS group and the PCS group at 3d,7d and 14d.11(75.0%)patients in PCS group achieved better function outcome,while,15(60.0%)patients in ACS group achieved better function outcome,there was no significant difference between two groups(P >0.05).Conclusion: 1.Tirofiban hydrochloride use in patients with END at the first 24 hours after intravenous thrombolysis is safe and efficient,it prevents further deterioration of neurological function without increasing the risk of bleeding and adverse reactions,and improves the clinical outcome of AIS patients.2.For mild END patients with fluctuation in the neurological symptoms with no significant increase in NIHSS scores,using of tirofiban hydrochloride is also reasonable and can improve the neurological function in patients.Tirofiban hydrochloride is safe for patients with moderate and severe stroke.3.Using of tirofiban hydrochloride can improve the neurological function after END in both SAO and LAA group,the efficacy of tirofiban in SAO group was better than LAA group.In this study.4.Using of tirofiban hydrochloride can improve the neurological function in both PCS and ACS group,the application of tirofiban hydrochloride in PCS patients is reasonable.