Effects of tirofiban on large vessel occlusion stroke are modified by etiology and renal function

作者全名："Liu, Chang; Li, Fengli; Chen, Liyuan; Huang, Jiacheng; Sang, Hongfei; Nguyen, Thanh N.; Saver, Jeffrey L.; Abdalkader, Mohamad; Kong, Weiling; Yang, Jie; Guo, Changwei; Gong, Chen; Huang, Liping; Pan, Yanzhu; Wang, Xinxin; Chen, Yangmei; Qiu, Zhongming; Zi, Wenjie"

作者地址："[Liu, Chang; Chen, Liyuan; Huang, Jiacheng; Gong, Chen; Huang, Liping; Pan, Yanzhu; Wang, Xinxin; Chen, Yangmei] Chongqing Med Univ, Affiliated Hosp 2, Dept Neurol, Chongqing, Peoples R China; [Li, Fengli; Kong, Weiling; Yang, Jie; Guo, Changwei; Zi, Wenjie] Third Mil Med Univ, Army Med Univ, Xinqiao Hosp, Dept Neurol, Chongqing, Peoples R China; [Li, Fengli; Kong, Weiling; Yang, Jie; Guo, Changwei; Zi, Wenjie] Third Mil Med Univ, Army Med Univ, Affiliated Hosp 2, Chongqing, Peoples R China; [Sang, Hongfei] Zhejiang Univ, Sch Med, Affiliated Hangzhou Peoples Hosp 1, Neurol, Hangzhou, Peoples R China; [Nguyen, Thanh N.] Boston Univ, Boston Med Ctr, Chobanian & Avedisian Sch Med, Dept Neurol, Boston, MA USA; [Saver, Jeffrey L.] Univ Calif Los Angeles, Neurol, Los Angeles, CA USA; [Abdalkader, Mohamad] Boston Univ, Boston Med Ctr, Chobanian & Avedisian Sch Med, Dept Radiol, Boston, MA USA; [Qiu, Zhongming] 903rd Hosp Chinese Peoples Liberat Army, Dept Neurol, Hangzhou, Peoples R China"

通信作者："Chen, YM (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Dept Neurol, Chongqing, Peoples R China.; Zi, WJ (通讯作者)，Third Mil Med Univ, Army Med Univ, Xinqiao Hosp, Dept Neurol, Chongqing, Peoples R China.; Zi, WJ (通讯作者)，Third Mil Med Univ, Army Med Univ, Affiliated Hosp 2, Chongqing, Peoples R China.; Qiu, ZM (通讯作者)，903rd Hosp Chinese Peoples Liberat Army, Dept Neurol, Hangzhou, Peoples R China."

来源：ANNALS OF CLINICAL AND TRANSLATIONAL NEUROLOGY

ESI学科分类：NEUROSCIENCE & BEHAVIOR

WOS号：WOS:001133200000001

JCR分区：Q1

影响因子：5.3

年份：2023

卷号：　

期号：　

开始页：　

结束页：　

文献类型：Article; Early Access

关键词：　

摘要："ObjectiveRenal function can modify the outcomes of large vessel occlusion (LVO) stroke across stroke etiologies in disparate degrees. The presence of renal function deficit can also impair the pharmacokinetics of tirofiban. Hence, this study aimed to investigate the roles of renal function in determining efficacy and safety of intravenous tirofiban before endovascular treatment (EVT) for acute ischemic stroke patients with large vessel occlusion (LVO).MethodsThis study was a post hoc exploratory analysis of the RESCUE-BT trial. The primary outcome was the proportion of patients achieving functional independence (modified Rankin scale 0-2) at 90 days, and the primary safety outcome was the rate of symptomatic intracranial hemorrhage (sICH).ResultsAmong 908 individuals with available serum creatinine, decreased estimated glomerular filtration rate (eGFR) status was noted more commonly in patients with cardioembolic stroke (CE), while large artery atherosclerosis (LAA) was predominant in patients with normal renal function. In LAA with normal renal function, tirofiban was associated with higher rates of functional independence at 90 days (41.67% vs 59.80%, p = 0.003). However, for LVO patients with renal dysfunction, tirofiban did not improve functional outcomes for any of the etiologies (LAA, p = 0.876; CE, p = 0.662; others, p = 0.894) and significantly increased the risk of sICH among non-LAA patients (p = 0.020). Mediation analysis showed tirofiban reduced thrombectomy passes (12.27%) and drug/placebo to recanalization time (14.25%) mediated its effects on functional independence.ConclusionThis present study demonstrated the importance of evaluating renal function before administering intravenous tirofiban among patients with LVO who are planned to undergo EVT."

基金机构：Chongqing Technology Innovation and Application Development Project

基金资助正文：We thank all study participants for their contribution to the study and the research staff at all the participating hospitals.