Background and purpose

Over half of patients with acute ischemic stroke present with minor neurologic deficits. We investigated the effects of oral antiplatelet agents vs. tirofiban, a highly selective GP IIb/IIIa antiplatelet drug, on functional outcomes of stroke patients with non-disabling neurologic deficits.

Methods

This retrospective study analyzed data of 125 patients with minor stroke who had National Institutes of Health Stroke Scale (NIHSS) scores of 5 or less within 6 hours of stroke symptom onset between January 2010 and June 2018. All patients were selected from the Department of Neurology at the Third Affiliated Hospital of Army Medical University. There were 54 cases in each group after propensity score matching, in which patients received oral antiplatelet agents (n = 64) and tirofiban (n = 61). Safety outcomes were assessed by incident intracranial hemorrhage, systemic bleeding and death. Efficacy outcomes were assessed using the NIHSS score at 24 hrs, 7 days or at discharge, and clinical deterioration. The modified rankin scale (mRs) was assessed at 90 days.

Results

No significant differences were found in the incidence of intracranial hemorrhage, systemic bleeding or death between groups (P>0.05). Although neurological function improved significantly in both groups, NIHSS scores were lower in the tirofiban group compared with those in the oral antiplatelet agents group at 24 hrs (1 versus 3, P = 0.000), 7 days or at discharge (0 versus 2, P = 0.000). The clinical deterioration rate was higher in the oral antiplatelet agents group than in the tirofiban group, but without significance (16.7% versus 5.6%, P = 0.126). Functional outcomes (mRs = 0) were more favorable in the tirofiban group than in the oral antiplatelet agents group (66.7% vs. 44.4%; adjusted odds ratio 3.32; 95% CI: 1.38–7.99; P = 0. 008).

Conclusion

Intravenous tirofiban seems to be safe and effective with more favorable functional outcomes than oral antiplatelet agents, suggesting that tirofiban is a viable treatment choice for selected patients with non-disabling minor acute ischemic stroke.

中文翻译：

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口服抗血小板药和替罗非班对非致残性轻度急性缺血性卒中患者功能结局的影响。

背景和目的

超过一半的急性缺血性中风患者存在轻微的神经功能缺损。我们研究了口服抗血小板药物与替罗非班（一种高度选择性的GP IIb / IIIa抗血小板药物）对无残疾神经功能缺损的中风患者的功能结局的影响。

方法

这项回顾性研究分析了2010年1月至2018年6月中风症状发作6小时内美国国立卫生研究院卒中量表（NIHSS）得分为5分或更低的125例轻度中风患者的数据。在陆军医科大学第三附属医院。倾向评分匹配后，每组有54例患者接受口服抗血小板药（n  = 64）和替罗非班（n  = 61）。通过颅内出血，全身性出血和死亡来评估安全性结果。使用NIHSS评分在24小时，7天或出院时以及临床恶化时评估疗效结果。在90天时评估改良的兰金量表（mRs）。

结果

两组之间颅内出血，全身性出血或死亡的发生率无显着差异（P> 0.05）。尽管两组的神经功能均明显改善，但替罗非班组在24小时（1比3，P  = 0.000），7天或出院时（0比2，P，NIHSS评分均低于口服抗血小板药组。 = 0.000）。口服抗血小板药组的临床恶化率高于替罗非班组，但无统计学意义（16.7％对5.6％，P  = 0.126）。替罗非班组的功能结局（mRs = 0）比口服抗血小板药组更好（66.7％vs. 44.4％；调整后的优势比为3.32； 95％CI：1.38–7.99；P  =0。008）。

结论

静脉使用替罗非班似乎比口服抗血小板药更安全，更有效，其功能结果优于口服抗血小板药，这表明替罗非班对于某些非致残性轻度急性缺血性卒中患者是一种可行的治疗选择。