According to the results of study published in Scientific Reports, prophylactic tirofiban infusion appears to lower the incidence of acute intracranial intraprocedural stent thrombosis, without increasing the risk of periprocedural intracranial hemorrhage and 30-day total mortality, compared with conventional stenting angioplasty without tirofiban.
To assess the safety and efficacy of prophylactic tirofiban, a potent glycoprotein IIb/IIIa inhibitor, for acute intracranial intraprocedural stent thrombosis in routine clinical practice, the investigators retrospectively reviewed data of consecutive patients who were treated with endovascular stenting for symptomatic, severe intracranial atherosclerotic stenosis at a single center in China between January 2013 and December 2019.
Patients were categorized into 2 groups treated with or without prophylactic tirofiban. From a total of 337 patients (tirofiban group, n=160; non-tirofiban group, n=177), the researchers used propensity score matching to select 236 matched patients (n=118 each group), who had an average age of 60.7±8.2 years. Most patients were male (70.3%) and had a history of hypertension (72.0%).
Overall, 9 acute intraprocedural stent thromboses occurred, 1 in the tirofiban group and 8 in the non-tirofiban group. The incidence of acute intraprocedural stent thrombosis was significantly lower in the tirofiban group than in the non-tirofiban group (0.8% vs 6.8%; P =.039). No statistically significant differences were observed in periprocedural ischemic events (8.5% vs 5.1%; P =.424), periprocedural intracranial hemorrhage (4.2% vs 0.8%; P =.219) or 30-day total mortality (3.4% vs 0%; P =.125) between the tirofiban and non-tirofiban groups.
Limitations of the study included the single-center, retrospective, nonrandomized design, lack of racial/ethnic diversity in the cohort, operator-dependent choice of treatment method, lack of subgroup analyses due to the small matched sample size, and a short follow-up duration.
“Compared with conventional stenting angioplasty without tirofiban, tirofiban prophylactic infusion can lower the incidence of [acute intraprocedural stent thrombosis], without increasing the risk of periprocedural [intracranial hemorrhage] and 30-day total mortality,” the authors concluded in their report. “However, there is no superiority in reducing periprocedural ischemic events.”
The authors noted that findings should be interpreted cautiously and warrant further study with prospective randomized studies for confirmation.
Sun L, Zhang J, Song Y, et al. Safety and efficacy of prophylactic tirofiban infusion for acute intracranial intraprocedural stent thrombosis. Sci Rep. 2021;11(1):21326. Published 2021 Oct 29. doi:10.1038/s41598-021-00872-9