Efficacy, safety, and effect on platelet activation of the timing of administration of tirofiban in patients with acute ischemic stroke.

Abstract

Objective: To evaluate the efficacy, safety, and effects on platelet activation of tirofiban administered at different times in patients with acute ischemic stroke, with the goal of providing precise guidance for clinical treatment timing.

Methods: A total of 262 patients with acute ischemic stroke admitted to No. 215 Hospital of Shaanxi Nuclear Industry between January 2021 and June 2023 were retrospectively analyzed. Patients were divided into an early treatment group (ETG, n = 124) and a late treatment group (LTG, n = 138) based on the timing of tirofiban administration. The ETG received tirofiban within 6 hours after thrombolysis, while the LTG received it 6 to 24 hours after thrombolysis. Clinical efficacy was evaluated post-treatment, and adverse reactions during treatment were recorded. Comparisons were made for pre- and post-treatment National Institutes of Health Stroke Scale (NIHSS) scores, Modified Rankin Scale (mRS) scores, neurological function markers, coagulation factors, inflammatory markers, and homocysteine (Hcy) levels. Correlations between efficacy and post-treatment indicators were analyzed, and logistic regression identified factors influencing outcome.

Results: The ETG demonstrated significantly better overall efficacy than the LTG (P = 0.004). Post-treatment NIHSS and mRS scores, neuron-specific enolase (NSE), platelet-activating factor (PAF), high-sensitivity C-reactive protein (hs-CRP), Hcy, and interleukin-1β (IL-1β) levels were significantly lower in the ETG, while brain-derived neurotrophic factor (BDNF) levels were higher (all P < 0.001). Clinical efficacy correlated significantly with post-treatment mRS scores, PAF levels, and Hcy levels (all P < 0.001). The ETG also had significantly lower rates of re-occlusion (P = 0.001), cardiopulmonary complications (P = 0.004), and symptomatic cerebral hemorrhage (P = 0.035). Logistic regression showed that the LTG was associated with reduced efficacy (β = -4.469, P = 0.019), while higher post-treatment PAF (β = 2.437, P < 0.001) and Hcy levels (β = 1.782, P = 0.013) were linked to poorer outcome.

Conclusion: Early administration of tirofiban in acute ischemic stroke offers significant clinical benefits, including improved neurological function and enhanced daily living abilities, with reduced inflammatory response and complications.