Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion

作者全名："Zi, Wenjie; Song, Jiaxing; Kong, Weilin; Huang, Jiacheng; Guo, Changwei; He, Wencheng; Yu, Yinquan; Zhang, Bo; Geng, Wanjie; Tan, Xiaolin; Tian, Yaoyu; Liu, Zongtao; Cao, Minghua; Cheng, Daoyou; Li, Bo; Huang, Wenguo; Liu, Junsheng; Wang, Pengfei; Yu, Zhou; Liang, Hao; Yang, Shuang; Tang, Mingshan; Liu, Wenhua; Huang, Xianjun; Liu, Shugai; Tang, Yufeng; Wu, Youlin; Yao, Li; Shi, Zhu; He, Pengcheng; Zhao, Haojin; Chen, Zhuo; Luo, Jun; Wan, Yue; Shi, Qiang; Wang, Maorong; Yang, De; Chen, Xianglin; Huang, Fang; Mu, Jinlin; Li, Hao; Li, Zhimin; Zheng, Jingbang; Xie, Shunli; Cai, Tieying; Peng, Yuqi; Xie, Weihua; Qiu, Zhongming; Liu, Chang; Yue, Chengsong; Li, Linyu; Tian, Yan; Yang, Dahong; Miao, Jian; Yang, Jie; Hu, Jinrong; Nogueira, Raul G.; Wang, Duolao; Saver, Jeffrey L.; Li, Fengli; Yang, Qingwu"

作者地址："[Zi, Wenjie; Song, Jiaxing; Kong, Weilin; Huang, Jiacheng; Guo, Changwei; Qiu, Zhongming; Yue, Chengsong; Li, Linyu; Tian, Yan; Yang, Dahong; Yang, Jie; Li, Fengli; Yang, Qingwu] Army Med Univ, Xinqiao Hosp, Dept Neurol, Mil Med Univ 3, Chongqing, Peoples R China; [Zi, Wenjie; Song, Jiaxing; Kong, Weilin; Huang, Jiacheng; Guo, Changwei; Qiu, Zhongming; Yue, Chengsong; Li, Linyu; Tian, Yan; Yang, Dahong; Yang, Jie; Hu, Jinrong; Li, Fengli; Yang, Qingwu] Army Med Univ, Affiliated Hosp 2, Third Mil Med Univ, Chongqing, Peoples R China; [Zi, Wenjie; Li, Fengli; Yang, Qingwu] Chongqing Inst Brain & Intelligence, Guangyang Bay Lab, Chongqing, Peoples R China; [Tang, Mingshan] Peoples Hosp Chongqing Banan Dist, Dept Neurol, Chongqing, Peoples R China; [Yang, De] Chongqing Univ, Fuling Hosp, Dept Neurol, Chongqing, Peoples R China; [Zheng, Jingbang] Chongqing Sanbo Changan Hosp, Dept Internal Med 2, Chongqing, Peoples R China; [Xie, Shunli; Cai, Tieying] Youyang Cty Peoples Hosp, Dept Neurol, Xinyang, Peoples R China; [Liu, Chang] Chongqing Med Univ, Dept Neurol, Affiliated Hosp 2, Chongqing, Peoples R China; [Huang, Wenguo] Guiping Peoples Hosp, Dept Neurol, Guiping, Peoples R China; [Yu, Yinquan] Bazhong Hosp Tradit Chinese Med, Dept Neurol, Bazhong, Peoples R China; [Li, Bo] Bazhong Cent Hosp, Dept Neurol, Bazhong, Peoples R China; [Liu, Junsheng] Peoples Hosp Pingchang, Dept Neurol, Bazhong, Peoples R China; [Mu, Jinlin] Nanjiang Hosp Tradit Chinese Med, Dept Neurol, Suzhou, Peoples R China; [Zhang, Bo] Suining First Peoples Hosp, Dept Neurol, Suining, Peoples R China; [Geng, Wanjie] Taihe Cty Peoples Hosp, Dept Neurol, Fuyang, Peoples R China; [Li, Zhimin] Taihe Cty Hosp Tradit Chinese Med, Dept Neurol, Fuyang, Peoples R China; [Tan, Xiaolin] Meishan Second Peoples Hosp, Dept Neurol, Meishan, Peoples R China; [Tian, Yaoyu] Qian Xi Nan Peoples Hosp, Dept Neurol, Xingyi, Peoples R China; [Cao, Minghua] Jingdezhen 1 Peoples Hosp, Dept Neurol, Jingdezhen, Peoples R China; [Cheng, Daoyou] Xingyi Peoples Hosp, Dept Neurol, Xingyi, Peoples R China; [Huang, Wenguo] Maoming Hosp Tradit Chinese Med, Dept Encephalopathy, Maoming, Peoples R China; [Wang, Pengfei] Weihai Municipal Hosp, Dept Neurol, Weihai, Peoples R China; [Wang, Pengfei] Weihai Municipal Hosp, Dept Neurol, Weihai, Peoples R China; [Yu, Zhou] Liangshan First Peoples Hosp, Dept Neurol, Xichang, Peoples R China; [Liang, Hao] Peoples Hosp Luyi, Dept Neurol, Zhoukou, Peoples R China; [Yang, Shuang] Peoples Hosp Zunyi City Bo Zhou Dist, Dept Neurol, Zunyi, Peoples R China; [Liu, Wenhua] Wuhan Hosp Tradit Chinese & Western Med, Dept Neurol, Wuhan, Peoples R China; [Wu, Youlin] Third Peoples Hosp Hubei Prov, Dept Neurol, Wuhan, Peoples R China; [Huang, Xianjun] First Affiliated Hosp, Wannan Med Coll, Wuhu, Peoples R China; [Liu, Shugai] Guangyuan Cent Hosp, Dept Cerebrovasc Dis, Guangyuan, Peoples R China; [Tang, Yufeng] Mianyang Cent Hosp, Dept Neurol, Mianyang, Sichuan, Peoples R China; [Luo, Jun] Sichuan Mianyang 404 Hosp, Dept Cerebrovasc Dis, Mianyang, Sichuan, Peoples R China; [Wang, Maorong] Peoples Hosp Zitong Cty, Dept Neurol, Zitong Cty, Peoples R China; [Peng, Yuqi] Sichuan Sci City Hosp, Dept Neurol, Mianyang, Sichuan, Peoples R China; [Wu, Youlin] Chongzhou Peoples Hosp, Dept Neurol, Chengdu, Peoples R China; [Yao, Li] Xian XD Grp Hosp, Dept Neurol, Xian, Peoples R China; [Shi, Zhu] Southern Med Univ, Dept Neurol, Affiliated Dongguan Peoples Hos, Dongguan, Peoples R China; [He, Pengcheng] Peoples Hosp Nanbu Cty, Dept Neurol, Nanchong, Peoples R China; [Li, Zhimin] North Sichuan Med Coll, Dept Neurol, Affiliated Hosp, Nanchong, Peoples R China; [Zhao, Haojin] Second Peoples Hosp Mengjin Dist, Dept Neurol, Luoyang, Peoples R China; [Chen, Zhuo] Mianzhu Peoples Hosp, Dept Neurol, Deyang, Peoples R China; [Shi, Qiang] Zigong First Peoples Hosp, Dept Neurol, Zigong, Peoples R China; [Chen, Xianglin] Guangzhou Med Univ, Qingyuan Peoples Hosp, Dept Neurol, Affiliated Hosp 6, Qingyuan, Peoples R China; [Huang, Fang] Peoples Hosp Yuxi City, Dept Cerebrovascular Dis, Yuxi, Peoples R China; [Li, Hao] First Peoples Hosp Yibin, Dept Neurol, Yibin, Peoples R China; [Xie, Weihua] Peoples Hosp Mengzi, Dept Neurol, HaniYi Autonomous Prefec, Mengzi, Peoples R China; [Miao, Jian] Xianyang Hosp Yanan Univ, Dept Neurol, Xianyang, Peoples R China; [Nogueira, Raul G.] Univ Pittsburgh, Stroke Inst, Dept Neurol & Neurosurg, Sch Med,Med Ctr, Pittsburgh, PA USA; [Wang, Duolao] Univ Liverpool Liverpool Sch Trop Med, Global Hlth Trials Unit, Liverpool, Merseyside, England; [Saver, Jeffrey L.] UCLA, David Geffen Sch Med, Dept Neurol, Los Angeles, CA USA"

通信作者："Yang, QW (通讯作者)，Army Med Univ, Dept Neurol, Xinqiao Hosp, Mil Med Univ 3, 183 Xinqiao Main St, Chongqing 400037, Peoples R China.; Yang, QW (通讯作者)，Army Med Univ, Mil Med Univ 3, Affiliated Hosp 2, 183 Xinqiao Main St, Chongqing 400037, Peoples R China."

来源：NEW ENGLAND JOURNAL OF MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001078029600006

JCR分区：Q1

影响因子：96.2

年份：2023

卷号：388

期号：22

开始页：2025

结束页：2036

文献类型：Article

关键词：　

摘要："BACKGROUND The effects of the glycoprotein IIb/IIIa receptor inhibitor tirofiban in patients with acute ischemic stroke but who have no evidence of complete occlusion of large or medium-sized vessels have not been extensively studied. METHODS In a multicenter trial in China, we enrolled patients with ischemic stroke without occlusion of large or medium-sized vessels and with a National Institutes of Health Stroke Scale score of 5 or more and at least one moderately to severely weak limb. Eligible patients had any of four clinical presentations: ineligible for thrombolysis or thrombectomy and within 24 hours after the patient was last known to be well; progression of stroke symptoms 24 to 96 hours after onset; early neurologic deterioration after thrombolysis; or thrombolysis with no improvement at 4 to 24 hours. Patients were assigned to receive intravenous tirofiban (plus oral placebo) or oral aspirin (100 mg per day, plus intravenous placebo) for 2 days; all patients then received oral aspirin until day 90. The primary efficacy end point was an excellent outcome, defined as a score of 0 or 1 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. Secondary end points included functional independence at 90 days and a quality-of-life score. The primary safety end points were death and symptomatic intracranial hemorrhage. RESULTS A total of 606 patients were assigned to the tirofiban group and 571 to the aspirin group. Most patients had small infarctions that were presumed to be atherosclerotic. The percentage of patients with a score of 0 or 1 on the modified Rankin scale at 90 days was 29.1% with tirofiban and 22.2% with aspirin (adjusted risk ratio, 1.26; 95% confidence interval, 1.04 to 1.53, P=0.02). Results for secondary end points were generally not consistent with the results of the primary analysis. Mortality was similar in the two groups. The incidence of symptomatic intracranial hemorrhage was 1.0% in the tirofiban group and 0% in the aspirin group. CONCLUSIONS In this trial involving heterogeneous groups of patients with stroke of recent onset or progression of stroke symptoms and nonoccluded large and medium-sized cerebral vessels, intravenous tirofiban was associated with a greater likelihood of an excellent outcome than low-dose aspirin. Incidences of intracranial hemorrhages were low but slightly higher with tirofiban."

基金机构：National Natural Science Foundation of China (Major Program) [82090040]

基金资助正文："Supported by the National Natural Science Foundation of China (Major Program) (project number, 82090040)."