BACKGROUND There has not been any effective prophylaxis for delayed cerebral ischemia delayed cerebral ischemia (DCI) since the introduction of nimodipine. Platelet inhibition may reduce the risk by preventing the formation of microthrombi. Tirofiban has been used as a single monotherapy bridge given its safety profile and controlled platelet inhibition. OBJECTIVE To assess the risk of DCI in aneurysmal subarachnoid hemorrhages (aSAH) patients treated with the tirofiban protocol. METHODS aSAH patients between December 2010 and March 2019 who were treated with stent assisted coiling or flow-diverting device were started on a continuous tirofiban infusion protocol and were compared with patients who underwent coil embolization without antiplatelet therapy. Safety analysis was performed to assess DCI, hemorrhagic, and ischemic events. RESULTS A total of 21 patients were included in the tirofiban series and 81 in the control group. There was no statistical difference in age, gender, Hunt-Hess grade, and Fisher scale between the 2 groups except for a higher Fisher grade II in the tirofiban group. Multivariate analysis revealed tirofiban to reduce the risk of vasospasm by 72 percent (OR .28, P = .03), without affecting the risk of hemorrhagic complications (OR = 0.50, P = .26). Tirofiban reduced the risk of symptomatic stroke endovascular procedure but it did not reach significance (P = .06). DCI, older age, and postprocedural symptomatic stroke were significant predictors of mortality. Tirofiban reduced the mortality risk, but this association was not statistically significant. CONCLUSION The tirofiban protocol in aSAH patients reduces the risk of DCI without conferring additional risks. This supports previous findings were antiplatelet therapy reduced DCI in human and animal models.

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替罗非班协议防止延迟性脑缺血：病例系列研究

背景 自从引入尼莫地平后，迟发性脑缺血 (DCI) 还没有任何有效的预防措施。血小板抑制可以通过防止形成微血栓来降低风险。鉴于其安全性和可控的血小板抑制作用，替罗非班已被用作单一的单一疗法桥梁。目的 评估接受替罗非班方案治疗的动脉瘤性蛛网膜下腔出血 (aSAH) 患者发生 DCI 的风险。方法 2010 年 12 月至 2019 年 3 月期间接受支架辅助弹簧圈或分流装置治疗的 aSAH 患者开始接受连续替罗非班输注方案，并与接受弹簧圈栓塞术但未接受抗血小板治疗的患者进行比较。进行安全性分析以评估 DCI、出血和缺血事件。结果 共有 21 名患者被纳入替罗非班系列，81 名患者被纳入对照组。除替罗非班组较高的Fisher II级外，2组在年龄、性别、Hunt-Hess分级和Fisher量表方面无统计学差异。多变量分析显示，替罗非班可将血管痉挛风险降低 72% (OR .28, P = .03)，同时不影响出血并发症的风险 (OR = 0.50, P = .26)。替罗非班降低了有症状的卒中血管内手术的风险，但没有达到显着性（P = .06）。DCI、高龄和术后症状性卒中是死亡率的重要预测因素。替罗非班降低了死亡风险，但这种关联没有统计学意义。结论 aSAH 患者的替罗非班方案降低了 DCI 的风险，而不会带来额外的风险。这支持先前的研究结果，即抗血小板治疗降低了人类和动物模型中的 DCI。