Combined Approach to Eptifibatide and Thrombectomy in Acute Ischemic Stroke Because of Large Vessel Occlusion: A Matched-Control Analysis
Author:
Ma Gaoting1ORCID, Sun Xuan1, Cheng Huiran2, Burgin W. Scott3ORCID, Luo Weiliang4, Jia Weihua5, Liu Yajie6, He Wenlong7, Geng Xiaokun8, Zhu Liangfu2, Chen Xingyu9, Shi Huaizhang10ORCID, Xu Haowen11, Zhang Litong12, Wang Anxin13ORCID, Mo Dapeng1ORCID, Ma Ning1ORCID, Gao Feng1, Song Ligang1, Huo Xiaochuan1ORCID, Deng Yiming1, Liu Lian114ORCID, Luo Gang1, Jia Baixue1, Tong Xu1ORCID, Liu Liping1ORCID, Ren Zeguang15ORCID, Miao Zhongrong1ORCID, Gui Liqiang, Wang Tianyu, Ma Xiang, Yang Chunshui, Gui Liqiang, Song Cunfeng, Peng Ya, Wu Jin, Zhao Shijun, Zhao Junfeng, Zhou Zhiming, Li Yongli, Jing Ping, Yang Lei, Zhao Qingshi, Liu Yan, Peng Xiaoxiang, Gao Qingchun, Guo Zaiyu, Chen Wenhuo, Li Weirong, Cheng Xiaojiang, Xu Yun, Zhang Yongqiang, Zhang Guilian, Lu Yijiu, Lu Xinyu, Wang Dengxiang, Wang Yan, Li Hao, Hua Yang, Geng Deqin, Yuan Haicheng, Wang Hongwei, Yang Haihua, Wang Zengwu, Wei Liping, Liufu Xuancong, Shi Xiangqun, Li Juntao, Yang Wenwu, Jing Wenji, Yong Xiang, Wang Leyuan, Li Chunlei, Cao Yibin, Zhu Qingfeng, Zhang Peng, Luo Xiang, Chen Shengli, Peng WenWu, Wang Lixin, Wen Xue, Shi Shugui, Wang Wanming, Bo Wang, Yuan Pu, Wang Dong, Guan Haitao, Liang Wenbao, Ma Daliang, Chen Long, Xiao Yan, Xie Xiangdong, Shi Zhonghua, Zeng Xiangjun, Su Fanfan, Chang MingZe, Yin Jijun, Sun Hongxia, Li Chong, Bi Yong, Xie Gang, Zhao Yuwu, Wang Chao, Zhang Peng, Wang Xianjun, Li Dongqun, Liang Hui, Chen Zhonglun, Wang Yan, Wang Yu Xin, Yin Lin, Qiu HongKai, Wei Jun, Sun Yaxuan, Feng Xiaoya, Wu Weihua, Gao Lianbo, Ai Zhibing, Lan Tan, Ding Li, Liang Qilong, Wang Zhimin, Yang Jianwen, Xu Ping, Dong Wei, Zheng Quanle, Zhu Zhenyun, Zhao Liyue, Meng Qingbo, Wei Yuqing, Chen Xianglin, Wang Wei, Sun Dong, Yan Yongxing, Yuan Guangxiong, Yang Yadong, Zhou Jianfeng, Yang Zhi, Zhang Zhenzhong, Guan Ning, Wang Huihong
Affiliation:
1. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China (G.M., X.S., D.M., N.M., F.G., L.S., X.H., Y.D., L.L., G.L., B.J., X.Y., Z.M.). 2. Department of Neurosurgery, Anyang People’s Hospital, China (H.C., L.Z.). 3. Department of Neurology, Morsani College of Medicine University of South Florida, Tampa (W.S.B.). 4. Department of Neurology, Huizhou Municipal Central Hospital, China (W.L.). 5. Department of Neurology, Beijing Shijingshan Teaching Hospital, Capital Medical University, China (W.J.). 6. Department of Neurology, Shenzhen Hospital, Southern Medical University, China (Y.L.). 7. Department of Neurology, Xinxiang Central Hospital, China (W.H.). 8. Department of Neurology, Beijing Luhe Hospital, Capital Medical University, China (X.G.). 9. Department of Neurology, Zhongshan Hospital Xiamen University, China (X.C.). 10. Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, China (H.S.). 11. Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, China (H.X,). 12. Department of Cerebral Vascular Diseases, Interventional Center, Henan Provincial People’s Hospital, Zhengzhou, China (L.Z.). 13. China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University (A.W.). 14. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (L.L.). 15. Department of Neurosurgery, University of South Florida, Tampa (Z.R.).
Abstract
Background:
In patients undergoing mechanical thrombectomy (MT), adjunctive antithrombotic might improve angiographic reperfusion, reduce the risk of distal emboli and reocclusion but possibly expose patients to a higher intracranial hemorrhage risk. This study evaluated the safety and efficacy of combined MT plus eptifibatide for acute ischemic stroke.
Methods:
This was a propensity-matched analysis of data from 2 prospective trials in Chinese populations: the ANGEL-ACT trial (Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischemic Stroke) in 111 hospitals between November 2017 and March 2019, and the EPOCH trial (Eptifibatide in Endovascular Treatment of Acute Ischemic Stroke) in 15 hospitals between April 2019 and March 2020. The primary efficacy outcome was good outcome (modified Rankin Scale score 0–2) at 3 months. Secondary efficacy outcomes included the distribution of 3-month modified Rankin Scale scores and poor outcome (modified Rankin Scale score 5–6) and successful recanalization. The safety outcomes included any intracranial hemorrhage, symptomatic intracranial hemorrhage, and 3-month mortality. Mixed-effects logistic regression models were used to account for within-hospital clustering in adjusted analyses.
Results:
Eighty-one combination arm EPOCH subjects were matched with 81 ANGEL-ACT noneptifibatide patients. Compared with the no eptifibatide group, the eptifibatide group had significantly higher rates of successful recanalization (91.3% versus 81.5%;
P
=0.043) and 3-month good outcomes (53.1% versus 33.3%;
P
=0.016). No significant difference was found in the remaining outcome measures between the 2 groups. All outcome measures of propensity score matching were consistent with mixed-effects logistic regression models in the total population.
Conclusions:
This matched-control study demonstrated that MT combined with eptifibatide did not raise major safety concerns and showed a trend of better efficacy outcomes compared with MT alone. Overall, eptifibatide shows potential as a periprocedural adjunctive antithrombotic therapy when combined with MT. Further randomized controlled trials of MT plus eptifibatide should be prioritized.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03844594 (EPOCH), NCT03370939 (ANGEL-ACT).
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)
Cited by
21 articles.
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