替罗非班治疗进展性缺血性卒中的疗效和安全性观察

A preliminary study on effectiveness and safety of Tirofiban for progressive ischemic stroke

目的探讨替罗非班治疗进展性缺血性卒中(progressive ischemic stroke,PIS)的有效性和安全性。方法收集我院2016年1-12月经替罗非班治疗的PIS患者6例,记录其人口学特征,缺血性卒中危险因素,新发梗死部位及相应卒中机制,替罗非班开始应用及持续时间、剂量,不同时间点的美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分以及并发症。结果 6例中,前后循环PIS各3例,卒中进展的机制包括大动脉或穿支动脉起始部粥样硬化基础上的血栓形成、栓子脱落、低灌注/栓子清除障碍。6例PIS患者静脉泵入替罗非班持续时间为34~184(75±54.4)h,单位时间泵入剂量为0.1~0.25(0.19±0.06)mg/h。治疗后7 d NIHSS评分平均下降3.0±2.1分,且无出血并发症。结论静脉应用替罗非班可能是一种相对安全有效的治疗PIS的方法。未来应进行多中心随机对照试验进一步验证。

Objective To explore the effectiveness and safety of tirofiban for progressive ischemic stroke（PIS）.Methods We collected six PIS patients treated with tirofiban who admitted to our hospital between January 2016 and December 2016.Demographic data,ischemic stroke risk factors,location of new infarction and etiologic mechanisms,time to tirofiban administration,duration and dosage.The National Institute of Health Stroke Scale（NIHSS） scores at different time points and complications were summarized.Results Six patients were included,and progressive ischemic stroke lesions located in anterior circulation in 3 cases and in posterior circulation in 3 cases,respectively.Underlying mechanisms of progression included large artery or penetrating artery initial segment atherothrombosis,artery-to-artery embolism,and hemodynamic impairment/impaired emboli clearance.The duration of tirofiban infusion was 34–184（75±54.4） h with the dosage of 0.1-0.25（0.19±0.06） mg/h.NIHSS score reduced by 3.0±2.1 points at 7 days after tirofiban infusion.No hemorrhagic complications were observed.Conclusion Tirofiban may be able to prevent early worsening of ischemic stroke without increasing the risk of bleeding.Further studies of tirofiban for PIS are needed.