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

Author:

Liu Chang1,Li Fengli2ORCID,Chen Liyuan1,Huang Jiacheng1ORCID,Sang Hongfei3,Nguyen Thanh N.4,Saver Jeffrey L.5,Abdalkader Mohamad6,Kong Weiling2,Yang Jie2,Guo Changwei2,Gong Chen1,Huang Liping1,Pan Yanzhu1,Wang Xinxin1,Chen Yangmei1,Qiu Zhongming7ORCID,Zi Wenjie2ORCID

Affiliation:

1. Department of Neurology The Second Affiliated Hospital, Chongqing Medical University Chongqing China

2. Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital Army Medical University (Third Military Medical University) Chongqing China

3. Neurology, Affiliated Hangzhou First People's Hospital Zhejiang University School of Medicine Hangzhou China

4. Department of Neurology, Boston Medical Center Boston University Chobanian and Avedisian School of Medicine Boston Massachusetts USA

5. Neurology University of California in Los Angeles Los Angeles California USA

6. Department of Radiology, Boston Medical Center Boston University Chobanian and Avedisian School of Medicine Boston Massachusetts USA

7. Department of Neurology, The 903rd Hospital of The Chinese People's Liberation Army Hangzhou China

Abstract

AbstractObjectiveRenal 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.

Funder

National Natural Science Foundation of China

Publisher

Wiley

Subject

Neurology (clinical),General Neuroscience

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