替罗非班与阿加曲班治疗急性缺血性脑卒中的效果比较

Clinical efficacy of tirofiban versus argatroban in the treatment of acute ischemic stroke

目的比较替罗非班与阿加曲班治疗急性缺血性脑卒中的疗效及安全性。方法该研究为回顾性队列研究,将2022年8月至2023年9月湖北省第三人民医院神经内科连续性收治的急性缺血性脑卒中患者68例按治疗方案分为替罗非班组(33例)及阿加曲班组(35例)。两组按各自的治疗方案治疗7 d,根据脑卒中改良Rankin量表(mRS)评分判断临床结局,比较两组治疗后90 d时优秀临床结局(mRS评分0~1分)、良好临床结局(mRS评分0~2分)、症状性颅内出血以及病死率。结果替罗非班组优秀临床结局为30.3%(10/33),低于阿加曲班组的65.7%(23/35)(χ^(2)=8.53,P=0.003);但两组良好临床结局比例差异无统计学意义[54.5%(18/33)比74.3%(26/35)](χ^(2)=2.90,P=0.089)。两组在症状性颅内出血、病死率等方面差异均无统计学意义(均P>0.05)。结论对于急性缺血性脑卒中患者,使用替罗非班或阿加曲班是有效的、安全的。阿加曲班组取得优秀临床结局可能性更大,但需要更大的随机对照研究加以进一步证实。

Objective To investigate the efficacy and safety of tirofiban versus argatroban in the treatment of acute ischemic stroke.Methods This study was a retrospective cohort study.Sixty-eight patients with acute ischemic stroke who were continuously admitted to Department of Neurology of The Third People's Hospital of Hubei Province from August 2022 to September 2023 were divided into tirofiban group(n=33)and argatroban group(n=35)according to the treatment regimen.Both groups were treated according to their respective treatment protocols for 7 days.Clinical outcomes were assessed based on the modified Rankin Scale(mRS)scores.The excellent clinical outcome(mRS score 0-1 points),good clinical outcome(mRS score 0-2 points),symptomatic intracranial hemorrhage,and mortality rates were compared between the two groups at 90 days post-treatment.Results In the tirofiban group,the proportion of excellent clinical outcomes was 30.3%(10/33),which was significantly lower than the 65.7%(23/35)in the argatroban group(χ^(2)=8.53,P·=0.003).However,the difference in the proportion of good clinical outcomes between the two groups was not statistically significant[54.5%(18/33)vs.74.3%(26/35),χ^(2)=2.90,P=0.089].There were no statistically significant differences between the two groups regarding symptomatic intracranial hemorrhage and mortality rates(both P>0.05).Conclusion For patients with acute ischemic stroke,the use of tirofiban or argatroban is effective and safe.Patients treated with argatroban are more likely to achieve excellent clinical outcomes;however,larger randomized controlled trials are needed for further confirmation.