Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofib...Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.展开更多
Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with A...Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with AIS admitted at the Yibin Fourth People’s Hospital,of which were computer-randomized into a control group(20 cases,with regular urokinase intravenous thrombolysis therapy)and a research group(20 cases,combined with early Tirofiban treatment)from January 2018 to December 2022.The intervention outcomes between these two groups were compared and analyzed.Result:The blood platelet-related parameters before treatment had no statistical difference between the two groups(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).The Barthel index before treatment in both groups had no statistical difference(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).Conclusion:Early Tirofiban treatment for patients with AIS after intravenous thrombolysis with urokinase could effectively regulate the blood platelet-related parameters,hence improving treatment benefits and living capacity for patients,with definite clinical benefits.展开更多
BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial...BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).METHODS:Seventy-eight STEMI patients with age>65 years who underwent emergency PCI were consecutively enrolled.These patients received conventional PCI and were randomly divided into a control group and a treatment group(n=39 per group).The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery.The treatment group received intracoronary injection of tirofiban and nicorandil,and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery.The following parameters were measured:TIMI grade,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG),STsegment resolution(STR)rate 2 hours post-operatively,resolution of ST-segment elevation(STR)at 2 hours postoperatively,peak level of serum CK-MB,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)at 7–10 days postoperatively,and major adverse cardiac events(MACEs)in-hospital and within 30 days post-operatively.RESULTS:Compared with the control group,more patients in the treatment group had TIMI 3 and TMPG 3,and STR after PCI was significantly higher.The treatment group also had significantly lower c TFC,lower infarction relative artery(IRA),lower peak CK-MB,and no reflow ratio after PCI.The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.CONCLUSION:The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve shortterm prognoses.展开更多
Background: In worldwide, the mortality rate of acute myocardial infarction(AMI) raises year by year. Although the applications of percutaneous coronary intervention(PCI) and anticoagulants effectively reduce the mort...Background: In worldwide, the mortality rate of acute myocardial infarction(AMI) raises year by year. Although the applications of percutaneous coronary intervention(PCI) and anticoagulants effectively reduce the mortality of patients with acute coronary syndrome(ACS), but also increase the incidence of bleeding. Therefore, drugs with stable anticoagulant effects are urgently required.Methods: We enrolled 894 patients with acute coronary syndrome who underwent percutaneous coronary intervention in Shenyang Northern Hospital from February 2010 to May 2012; 430 patients were included in the fondaparinux group(2.5mg/d), and 464 were included in the enoxaparin group(1mg/kg twice daily). Fondaparinux and enoxaparin were applied for 3–7 days. All patients were treated with tirofiban [10μg/kg for 3min initially and 0.15μg/(kg·min) for 1 to 3 days thereafter]. The primary efficacy endpoint was the incidence of a major adverse cerebrovascular or cardiovascular event. The primary safety endpoint was bleeding within 30 days and 1 year after percutaneous coronary intervention.Results: One-year data were available for 422 patients in the fondaparinux group and for 453 in the enoxaparin group. The incidence of a major adverse cerebrovascular or cardiovascular event(10.9% vs 12.6%, P=0.433) and cardiac mortality(0.5% vs 1.5%, P=0.116) were generally lower in the fondaparinux group than in the enoxaparin group, although the differences were not significant. Compared with the enoxaparin group, the fondaparinux group had a significantly decreased rate of bleeding at 30 days(0.9% vs 2.9%, P=0.040) and 1 year(2.4% vs 5.5%, P=0.018). In addition, the rate of major bleeding events was lower in the fondaparinux group, but this difference was not significant(0.2% vs 0.9%, 0.2% vs 1.1%).Conclusion: In tirofiban-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention, fondaparinux presented similar efficacy for ischemia events as enoxaparin. However, fondaparinux significantly decreased the incidence of bleeding, thus providing safer anticoagulation therapy.展开更多
Aim:The effects of tirofiban combined with nicorandil on effective reperfusion,and the levels of interleukin-4(IL-4)and soluble intercellular adhesion molecule-1(sICAM-1)after percutaneous coronary intervention(PCI)fo...Aim:The effects of tirofiban combined with nicorandil on effective reperfusion,and the levels of interleukin-4(IL-4)and soluble intercellular adhesion molecule-1(sICAM-1)after percutaneous coronary intervention(PCI)for chronic coronary total occlusion(CTO)were investigated.Method:From January 1,2017,to June 31,2019,a total of 40 patients with CTO receiving PCI in Shandong Qian-foshan Hospital were randomly divided into a control group(treated with single tirofiban)and a cocktail group(treated with nicorandil combined with tirofiban).Effective reperfusion was compared between groups.In addition,differences in coronary serum IL-4 and sICAM-1 levels before and 10 min after the operation were compared between groups,and the incidence rates of adverse reactions were observed.Finally,patient follow-up occurred at 1 month and 6 months,and the total incidence rates of adverse cardiac events in both groups were assessed.Results:The levels of IL-4 and sICAM-1 in the cocktail group significantly decreased after the operation(P<0.05).In addition,after the operation,significantly greater decreases in the IL-4 and sICAM-1 levels were observed in the cocktail group than the control group(P<0.05).The Seattle Angina Scale(SAQ)score of the cocktail group,compared with the control group,showed a significant improvement after vessel opening in the patients with CTO.At the 1-month follow-up,the SAQ score of the cocktail group,compared with the control group,indicated further improvements in terms of angina attack frequency.No significant differences were observed in the incidence rates of adverse reactions between groups(P>0.05).Conclusion:The treatment of patients with CTO undergoing PCI with nicorandil and tirofiban alleviated the inflam-matory response,improved the SAQ scores,and decreased the occurrence of angina pectoris in patients.Moreover,this treatment is safe and reliable,and has important clinical significance.展开更多
Objective: To study the effect of intracoronary sodium nitroprusside and tirofiban injection on myocardial injury in patients with no reflow in PCI. Methods: Patients with acute coronary syndrome who underwent PCI and...Objective: To study the effect of intracoronary sodium nitroprusside and tirofiban injection on myocardial injury in patients with no reflow in PCI. Methods: Patients with acute coronary syndrome who underwent PCI and had no reflow in Gong'an County People's Hospital in Hubei Province between August 2014 and July 2017 were selected as the research subjects and randomly divided into two groups, combined group accepted intracoronary sodium nitroprusside and tirofiban injection during PCI, and control group accepted intracoronary tirofiban injection during PCI. The serum levels of myocardial injury indexes, oxidative stress indexes and inflammatory mediators of the two groups were measured before treatment and 1 d after treatment. Results: 1 d after treatment, serum CK-MB, H-FABP, sFas, cMyBP-C, MPO, MDA, Caspase-3, MCP-1, IL-1β, IL-18, MMP2 and MMP9 levels of both groups were significantly lower than those before treatment whereas SOD and NQO-1 levels were higher than those before treatment, and serum CK-MB, H-FABP, sFas, cMyBP-C, MPO, MDA, Caspase-3, MCP-1, IL-1β, IL-18, MMP2 and MMP9 levels of combined group were significantly lower than those of control group whereas SOD and NQO-1 levels were higher than those control group. Conclusion: Intracoronary sodium nitroprusside and tirofiban injection can reduce the myocardial injury in patients with no reflow in PCI.展开更多
Objective:To study the effect of papaverine combined with tirofiban intracoronary injection on the degree of myocardial injury in patients with no reflow during percutaneous coronary intervention (PCI).Methods: Patien...Objective:To study the effect of papaverine combined with tirofiban intracoronary injection on the degree of myocardial injury in patients with no reflow during percutaneous coronary intervention (PCI).Methods: Patients who underwent PCI in Ankang Central Hospital between March 2014 and May 2017 were retrospectively studied and divided into two groups according to the intravascular drugs they received during PCI, combined group received papaverine combined with tirofiban intracoronary injection and control group received tirofiban intracoronary injection. The changes in myocardial injury indexes, platelet activation indexes and inflammatory molecules were measured before PCI as well as 24 h and 48 h after PCI.Results:Serum CK-MB, cTnI, MYO, IMA, CD62p, GPIIb/IIIa, MIP-1α, sICAM-1 and HMGB-1 levels as well as peripheral blood Lp-PLA2, PAF, P-selectin, ERK and NF-κB fluorescence intensity of both groups 24 h and 48 h after PCI were significantly lower than those before PCI, and serum CK-MB, cTnI, MYO, IMA, CD62p, GPIIb/IIIa, MIP-1α, sICAM-1 and HMGB-1 levels as well as peripheral blood Lp-PLA2, PAF, P-selectin, ERK and NF-κB fluorescence intensity of combined group 24 h and 48 h after PCI were significantly lower than those of control group.Conclusion: papaverine combined with tirofiban intracoronary injection for PCI can reduce the degree of myocardial injury.展开更多
Objective: To study the effect of tirofiban combined with PCI on myocardial damage and platelet activation in patients with STEMI. Methods: Patients with STEMI who were treated and underwent PCI in Wujiang First Peopl...Objective: To study the effect of tirofiban combined with PCI on myocardial damage and platelet activation in patients with STEMI. Methods: Patients with STEMI who were treated and underwent PCI in Wujiang First People's Hospital in Suzhou between March 2015 and February 2017 were selected as the research subjects and randomly divided into two groups, intervention group received tirofiban combined with PCI therapy, control group received routine PCI therapy, and the myocardial damage indexes and platelet activation indexes of two groups of patients were detected. Results: 24 h after PCI treatment, serum S100A/B, H-FABP, GDF-15, cTnT, FKN, MDA, sFas, sTWEAK and 8-OHdG levels of intervention group were obviously lower than those of control group;before PCI treatment and 24 h after PCI treatment, peripheral blood CD62p and PAC-1 expression intensity as well as serum P-selectin, thrombospondin and CD40 ligand levels of intervention group were obviously lower than those of control group. Conclusion: Tirofiban therapy before PCI can help alleviate myocardial damage and inhibit platelet activation.展开更多
Objective:To study the effect of shexiangbaoxin pill combined with tirofiban hydrochloride on related factors in elderly patients with acute coronary symdrome.Methods:A total of 96 elderly patients with acute coronary...Objective:To study the effect of shexiangbaoxin pill combined with tirofiban hydrochloride on related factors in elderly patients with acute coronary symdrome.Methods:A total of 96 elderly patients with acute coronary symdrome in our hospital from January 2015 to May 2018 were enrolled in this study. The subjects were divided into the control group (n=48) and the treatment group (n=48) randomly. The control group were treated with tirofiban hydrochloride, the treatment group were treated with shexiangbaoxin pill combined with tirofiban hydrochloride, and both the two groups were treated for 2 weeks. The PT, TT, APTT and serum FIB, CK-MB, cTnT, vWF, ET-1, NO, sICAM-1, MMP-9, hs-CRP of the two groups before and after treatment were compared. Results: There were no significantly differences of the PT, TT, APTT and serum FIB, CK-MB, cTnT, vWF, ET-1, NO, sICAM-1, MMP-9, hs-CRP of the two groups before treatment. The PT, TT, APTT and serum NO of the two groups after treatment were significantly higher than before treatment, the serum FIB, vWF, ET, sICAM-1, MMP-9, hs-CRP of the two groups after treatment were significantly lower than before treatment, and that of the treatment group after treatment were significantly better than the control group. The serum CK-MB, cTnT of the two groups after treatment were significantly higher than before treatment, but that of the treatment group after treatment were significantly lower than the control group.Conclusion:Shexiangbaoxin pill combined with tirofiban hydrochloride can significantly improve the blood coagulation function and reduce the Myocardial injury, vascular endothelial damage, inflammation of the elderly patients with acute coronary symdrome, and it was worthy clinical application.展开更多
Objective:To investigate the effect of tironon on inflammatory factors, endothelial function and cardiac function after interventional therapy in AMI patients.Methods:A total of 120 patients with acute myocardial infa...Objective:To investigate the effect of tironon on inflammatory factors, endothelial function and cardiac function after interventional therapy in AMI patients.Methods:A total of 120 patients with acute myocardial infarction in our hospital were selected as the research objects, all of them were in line with the indications of PCI operation. They were randomly divided into the observation group (60 cases) and the control group (60 cases). The control group was treated with aspirin and clopidogrel before and after PCI, and the observation group was treated with based on the use of tirofiban. Inflammatory factors, endothelial function and cardiac function index were detected and compared between the two groups.Results: Before treatment, there was no significant difference in hs-CRP, sCD40L and TNF-alpha levels in the two groups. After treatment, the hs-CRP of the two groups were (5.01±1.95) mg/L, (9.41±2.48) mg/L, sCD40L were (1.88±0.25) ng/mL, (2.77±0.27) ng/mL, TNF-α were (8.86±2.18) ng/L, (15.52±2.78) ng/L, respectively. The levels of hs-CRP, sCD40L and TNF-α in the two groups were all decreased, and the level of each index in the observation group was lower than that of the control group. There was no significant difference in NO, ET-1 and vWF levels between the two groups before treatment. After treatment, the NO of the two groups were (82.48±11.57) umol/L and (66.68±13.18) umol/L, respectively. The two groups of NO were all elevated, and the NO of the observation group was higher than that of the control group. After treatment, the ET-1 of the two groups were (55.03±6.58) ng/L, (66.17±5.42) ng/L, and vWF were (66.17±5.88)×10-2, (83.28±5.39)×10-2, respectively. The ET-1 and vWF of the two groups were all decreased, and the ET-1 and vWF of the observation group were lower than those of the control group. There was no significant difference in LVEF, LVESD and LVEDD between the two groups before treatment. After treatment, the LVEF, LVESD and LVEDD of the observation group were (63.87±6.43)%, (38.27±4.66) mm and (43.63±7.61) mm, respectively. The LVEF of the observation group was higher than that of the control group, and the LVESD and LVEDD were lower than that of the control group.Conclusion: Tirofiban can effectively improve the inflammatory factors, endothelial function and cardiac function of AMI patients after interventional therapy.展开更多
Objective:To evaluate the efficacy and safety of tirofiban hydrochloride in the treatment of ischemic stroke with thrombolytic therapy.Method:Two hundred patients with acute ischemic stroke thrombolysis were randomly ...Objective:To evaluate the efficacy and safety of tirofiban hydrochloride in the treatment of ischemic stroke with thrombolytic therapy.Method:Two hundred patients with acute ischemic stroke thrombolysis were randomly divided into the experimental group and the control group.The experimental group was given tirofiban with the addition of rtpa in the control group and the therapeutic effects of the two groups were compared.Results:In comparison with the control group,the NIHSS improvement rate was 98%in the experimental group within 14 days.The platelet aggregation rate and efficacy in the experimental group were significantly reduced than the control group(P<0.01).The major adverse reaction in the two groups was hemorrhage with an incidence rate of 3%.Conclusion:Tirofiban hydrochloride is a highly effective and selective platelet glycoprotein Ⅱb/Ⅲa receptor inhibitor,which is safe and effective in combination with heparin and aspirin.展开更多
Objective: To compare the effect of intracoronary arterial injection of tirofiban and sodium nitroprusside (SNP) on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) underw...Objective: To compare the effect of intracoronary arterial injection of tirofiban and sodium nitroprusside (SNP) on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coro-nary intervention (PCI). Methods: A total of 68 patients with acute STEMI who had no-reflow phenomenon during PCI were chosen and randomly divided into SNP group (n = 34) and tirofiban group (n = 34). Aiming at no-reflow phenomenon during PCI, with the use of microcatheters, intracoronary arterial injection of tirofiban was given in tirofiban group, while intracoronary bolus of SNP was given in SNP group. Coronary angiography was conducted to record TIMI flow grade of the infarct-related artery after 10 minutes. Plasma brain natriuretic peptide (BNP) was monitored before and after PCI (in 24 hours). With the help of ultrasound cardiogram, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) were recorded and compared in 30 days after PCI. Results: The ratio of TIMI grade 3 blood flow in tirofiban group was significantly higher than that in SNP group (76.5% (26/34) vs. 52.9% (18/34), p = .03)BNP levels in two groups had no statistical significance before PCI (p = .16), but in 24 h after PCI, BNP levels in tirofiban group were significantly lower than those in SNP group ((439.00 ± 4.90) μmol/L vs. (632.00 ± 3.63) μmol/L, p = .02)In 30 days after PCI, LVEF, LVEDD and LVESD in tirofiban group were all superior to those in SNP group (all p < .05). Conclusions: Intracoronary arterial injection of tirofiban was superior to SNP in improving no-reflow phenomenon in STEMI patients after PCI in the emergency treatment. Tirofiban therapy can increase coronary blood flow and myocardial perfusion after the occurrence of no-reflow phenomenon during PCI in STEMI patients, and improve long-term prognosis.展开更多
Objective:To observe the influence of tirofiban on the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI and provide scientific basis for treatment of acute myo...Objective:To observe the influence of tirofiban on the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI and provide scientific basis for treatment of acute myocardial infarction.Methods:A total of 100 cases of hypertensive cerebral hemorrhage patients in our hospital were selected and randomly divided into 2 groups: the control group (50 cases) and the observation group (50 cases). The conventional treatment of PCI was performed on both groups. Tirofiban injection was given to the observation group on the basis of conventional treatment. cTnI, BNP and echocardiography parameters (LVEF, LVEDD, LVESD) were detected before and after treatment.Results:The comparison of cTnI in the two groups before operation was not statistically significant. cTnI in the 2 groups increased 12 h and 24 h after operation. But the cTnI in observation group (0.10±0.23) ng/mL decreased more significantly than that in control group (0.24±0.31) ng/mL, the difference was considered to be statistically significant. The comparison of BNP in the two groups before operation was not statistically significant. BNP in the 2 groups decreased obviously 7 d and 30 d after operation. BNP in observation group decreased more significantly than that in control group and the difference was considered to be statistically significant LVEF in the observation group increased significantly compared with that in control group 7 d after operation. The comparison of LVEDD, LVESD were not considered to be statistically significant. LVEDD and LVESD in the observation group were lower than that in control group obviously 30 d after operation. While the LVEF in the observation group was still higher than that in the control group. The comparsion was considered to be statistically significant.Conclusion:Tirofiban can improve the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI. It can also decrease the heart injury as well as helping the recovery of heart function.展开更多
To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glyco- protein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without per- sistent ST elevation (...To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glyco- protein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without per- sistent ST elevation (acute coronary syndrome, ACS), a total of 200 patients were randomly assigned to a heparin group and a tirofiban+heparin group on double-blind basis and the treatment effects of the two protocols on ACS were compared when the patients of both groups were taking aspirin at the same time. The composite primary end-point events consisted of death, myocardial infarction, or re- fractory ischemia. Our results showed that the frequency of the composite primary end point events in 30 days was lower in tirofiban+heparin group as compared with that of heparin group (13.9% vs 29.3 %, P=0.010). The rates of the other composite end point events in the tirofiban+heparin group were also lower than those in the heparin group in 4.5 days and in 30 days. Bleeding complication occurred in 7.0% of the patients receiving heparin alone and in 12.7% of the patients receiving tirofiban and heparin in combination (P=0.1717). The study showed that the incidence of ischemic events in pa- tients with ACS receiving tirofiban+heparin was lower when compared with that of patients who re- ceived only heparin and aspirin, suggesting that tirofiban might be of special value in the treatment of ACS.展开更多
Objective: To compare clinical outcomes and safety of eptifibatide or tirofiban in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI). Methods:Thirty-six patients with ACS(un...Objective: To compare clinical outcomes and safety of eptifibatide or tirofiban in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI). Methods:Thirty-six patients with ACS(unstable angina/non-ST-segment elevation myocardial infarction, UA/NSTEMI) who underwent PCI were randomly divided into two groups to receive eptifibatide or tirofiban treatment. Eptifibatide or tirofiban was predominantly initiated in the catheter laboratory before the intervention. In-hospital and 30-day MACE outcomes; bleeding as well as platelet counting were investigated in those two groups. Results:No in-hospital and 30-day MACE event occurred in the two groups. The number of ischemia leads after treatment reduced compared to that before PCI in the two groups. There was improvement in the number of ischemia leads for 24 h after administration in the tirofiban group than those in eptifibatide group(4.21±2.46 vs. 3.89±3.31, P =0.03). The two groups showed no incidence of massive bleeding. Minor bleeding rates were 16.7% and 22.2% in the two groups respectively. Conclusion:Eptifibatide as an adjunct to PCI may further decrease the incidence of ischemia event in patients with ACS and improve the safety, but its long-term efficacy and side effects need further observation.展开更多
基金supported by the Natural Science Foundation of Inner Mongolia(No.2021MS08169)the Medical and health Science and Technology Project of Inner Mongolia(No.202201571).
文摘Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.
文摘Objective:Discussion and analysis of the effect of the early application of Tirofiban on acute ischemic stroke(AIS)after intravenous thrombolysis with urokinase.Method:The subjects of this study are 40 patients with AIS admitted at the Yibin Fourth People’s Hospital,of which were computer-randomized into a control group(20 cases,with regular urokinase intravenous thrombolysis therapy)and a research group(20 cases,combined with early Tirofiban treatment)from January 2018 to December 2022.The intervention outcomes between these two groups were compared and analyzed.Result:The blood platelet-related parameters before treatment had no statistical difference between the two groups(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).The Barthel index before treatment in both groups had no statistical difference(P>0.05),but the research group was higher than that of the control group after treatment(P<0.05).Conclusion:Early Tirofiban treatment for patients with AIS after intravenous thrombolysis with urokinase could effectively regulate the blood platelet-related parameters,hence improving treatment benefits and living capacity for patients,with definite clinical benefits.
文摘BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).METHODS:Seventy-eight STEMI patients with age>65 years who underwent emergency PCI were consecutively enrolled.These patients received conventional PCI and were randomly divided into a control group and a treatment group(n=39 per group).The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery.The treatment group received intracoronary injection of tirofiban and nicorandil,and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery.The following parameters were measured:TIMI grade,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG),STsegment resolution(STR)rate 2 hours post-operatively,resolution of ST-segment elevation(STR)at 2 hours postoperatively,peak level of serum CK-MB,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)at 7–10 days postoperatively,and major adverse cardiac events(MACEs)in-hospital and within 30 days post-operatively.RESULTS:Compared with the control group,more patients in the treatment group had TIMI 3 and TMPG 3,and STR after PCI was significantly higher.The treatment group also had significantly lower c TFC,lower infarction relative artery(IRA),lower peak CK-MB,and no reflow ratio after PCI.The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.CONCLUSION:The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve shortterm prognoses.
文摘Background: In worldwide, the mortality rate of acute myocardial infarction(AMI) raises year by year. Although the applications of percutaneous coronary intervention(PCI) and anticoagulants effectively reduce the mortality of patients with acute coronary syndrome(ACS), but also increase the incidence of bleeding. Therefore, drugs with stable anticoagulant effects are urgently required.Methods: We enrolled 894 patients with acute coronary syndrome who underwent percutaneous coronary intervention in Shenyang Northern Hospital from February 2010 to May 2012; 430 patients were included in the fondaparinux group(2.5mg/d), and 464 were included in the enoxaparin group(1mg/kg twice daily). Fondaparinux and enoxaparin were applied for 3–7 days. All patients were treated with tirofiban [10μg/kg for 3min initially and 0.15μg/(kg·min) for 1 to 3 days thereafter]. The primary efficacy endpoint was the incidence of a major adverse cerebrovascular or cardiovascular event. The primary safety endpoint was bleeding within 30 days and 1 year after percutaneous coronary intervention.Results: One-year data were available for 422 patients in the fondaparinux group and for 453 in the enoxaparin group. The incidence of a major adverse cerebrovascular or cardiovascular event(10.9% vs 12.6%, P=0.433) and cardiac mortality(0.5% vs 1.5%, P=0.116) were generally lower in the fondaparinux group than in the enoxaparin group, although the differences were not significant. Compared with the enoxaparin group, the fondaparinux group had a significantly decreased rate of bleeding at 30 days(0.9% vs 2.9%, P=0.040) and 1 year(2.4% vs 5.5%, P=0.018). In addition, the rate of major bleeding events was lower in the fondaparinux group, but this difference was not significant(0.2% vs 0.9%, 0.2% vs 1.1%).Conclusion: In tirofiban-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention, fondaparinux presented similar efficacy for ischemia events as enoxaparin. However, fondaparinux significantly decreased the incidence of bleeding, thus providing safer anticoagulation therapy.
基金supported by research grants from the Natural Science Foundation of Shandong Province[grant number ZR2017BH114],the National Natural Science Foundation of China[grant number 81700334],and Jinan Science and Technology Plan Project[grant number 201805058].
文摘Aim:The effects of tirofiban combined with nicorandil on effective reperfusion,and the levels of interleukin-4(IL-4)and soluble intercellular adhesion molecule-1(sICAM-1)after percutaneous coronary intervention(PCI)for chronic coronary total occlusion(CTO)were investigated.Method:From January 1,2017,to June 31,2019,a total of 40 patients with CTO receiving PCI in Shandong Qian-foshan Hospital were randomly divided into a control group(treated with single tirofiban)and a cocktail group(treated with nicorandil combined with tirofiban).Effective reperfusion was compared between groups.In addition,differences in coronary serum IL-4 and sICAM-1 levels before and 10 min after the operation were compared between groups,and the incidence rates of adverse reactions were observed.Finally,patient follow-up occurred at 1 month and 6 months,and the total incidence rates of adverse cardiac events in both groups were assessed.Results:The levels of IL-4 and sICAM-1 in the cocktail group significantly decreased after the operation(P<0.05).In addition,after the operation,significantly greater decreases in the IL-4 and sICAM-1 levels were observed in the cocktail group than the control group(P<0.05).The Seattle Angina Scale(SAQ)score of the cocktail group,compared with the control group,showed a significant improvement after vessel opening in the patients with CTO.At the 1-month follow-up,the SAQ score of the cocktail group,compared with the control group,indicated further improvements in terms of angina attack frequency.No significant differences were observed in the incidence rates of adverse reactions between groups(P>0.05).Conclusion:The treatment of patients with CTO undergoing PCI with nicorandil and tirofiban alleviated the inflam-matory response,improved the SAQ scores,and decreased the occurrence of angina pectoris in patients.Moreover,this treatment is safe and reliable,and has important clinical significance.
文摘Objective: To study the effect of intracoronary sodium nitroprusside and tirofiban injection on myocardial injury in patients with no reflow in PCI. Methods: Patients with acute coronary syndrome who underwent PCI and had no reflow in Gong'an County People's Hospital in Hubei Province between August 2014 and July 2017 were selected as the research subjects and randomly divided into two groups, combined group accepted intracoronary sodium nitroprusside and tirofiban injection during PCI, and control group accepted intracoronary tirofiban injection during PCI. The serum levels of myocardial injury indexes, oxidative stress indexes and inflammatory mediators of the two groups were measured before treatment and 1 d after treatment. Results: 1 d after treatment, serum CK-MB, H-FABP, sFas, cMyBP-C, MPO, MDA, Caspase-3, MCP-1, IL-1β, IL-18, MMP2 and MMP9 levels of both groups were significantly lower than those before treatment whereas SOD and NQO-1 levels were higher than those before treatment, and serum CK-MB, H-FABP, sFas, cMyBP-C, MPO, MDA, Caspase-3, MCP-1, IL-1β, IL-18, MMP2 and MMP9 levels of combined group were significantly lower than those of control group whereas SOD and NQO-1 levels were higher than those control group. Conclusion: Intracoronary sodium nitroprusside and tirofiban injection can reduce the myocardial injury in patients with no reflow in PCI.
文摘Objective:To study the effect of papaverine combined with tirofiban intracoronary injection on the degree of myocardial injury in patients with no reflow during percutaneous coronary intervention (PCI).Methods: Patients who underwent PCI in Ankang Central Hospital between March 2014 and May 2017 were retrospectively studied and divided into two groups according to the intravascular drugs they received during PCI, combined group received papaverine combined with tirofiban intracoronary injection and control group received tirofiban intracoronary injection. The changes in myocardial injury indexes, platelet activation indexes and inflammatory molecules were measured before PCI as well as 24 h and 48 h after PCI.Results:Serum CK-MB, cTnI, MYO, IMA, CD62p, GPIIb/IIIa, MIP-1α, sICAM-1 and HMGB-1 levels as well as peripheral blood Lp-PLA2, PAF, P-selectin, ERK and NF-κB fluorescence intensity of both groups 24 h and 48 h after PCI were significantly lower than those before PCI, and serum CK-MB, cTnI, MYO, IMA, CD62p, GPIIb/IIIa, MIP-1α, sICAM-1 and HMGB-1 levels as well as peripheral blood Lp-PLA2, PAF, P-selectin, ERK and NF-κB fluorescence intensity of combined group 24 h and 48 h after PCI were significantly lower than those of control group.Conclusion: papaverine combined with tirofiban intracoronary injection for PCI can reduce the degree of myocardial injury.
文摘Objective: To study the effect of tirofiban combined with PCI on myocardial damage and platelet activation in patients with STEMI. Methods: Patients with STEMI who were treated and underwent PCI in Wujiang First People's Hospital in Suzhou between March 2015 and February 2017 were selected as the research subjects and randomly divided into two groups, intervention group received tirofiban combined with PCI therapy, control group received routine PCI therapy, and the myocardial damage indexes and platelet activation indexes of two groups of patients were detected. Results: 24 h after PCI treatment, serum S100A/B, H-FABP, GDF-15, cTnT, FKN, MDA, sFas, sTWEAK and 8-OHdG levels of intervention group were obviously lower than those of control group;before PCI treatment and 24 h after PCI treatment, peripheral blood CD62p and PAC-1 expression intensity as well as serum P-selectin, thrombospondin and CD40 ligand levels of intervention group were obviously lower than those of control group. Conclusion: Tirofiban therapy before PCI can help alleviate myocardial damage and inhibit platelet activation.
文摘Objective:To study the effect of shexiangbaoxin pill combined with tirofiban hydrochloride on related factors in elderly patients with acute coronary symdrome.Methods:A total of 96 elderly patients with acute coronary symdrome in our hospital from January 2015 to May 2018 were enrolled in this study. The subjects were divided into the control group (n=48) and the treatment group (n=48) randomly. The control group were treated with tirofiban hydrochloride, the treatment group were treated with shexiangbaoxin pill combined with tirofiban hydrochloride, and both the two groups were treated for 2 weeks. The PT, TT, APTT and serum FIB, CK-MB, cTnT, vWF, ET-1, NO, sICAM-1, MMP-9, hs-CRP of the two groups before and after treatment were compared. Results: There were no significantly differences of the PT, TT, APTT and serum FIB, CK-MB, cTnT, vWF, ET-1, NO, sICAM-1, MMP-9, hs-CRP of the two groups before treatment. The PT, TT, APTT and serum NO of the two groups after treatment were significantly higher than before treatment, the serum FIB, vWF, ET, sICAM-1, MMP-9, hs-CRP of the two groups after treatment were significantly lower than before treatment, and that of the treatment group after treatment were significantly better than the control group. The serum CK-MB, cTnT of the two groups after treatment were significantly higher than before treatment, but that of the treatment group after treatment were significantly lower than the control group.Conclusion:Shexiangbaoxin pill combined with tirofiban hydrochloride can significantly improve the blood coagulation function and reduce the Myocardial injury, vascular endothelial damage, inflammation of the elderly patients with acute coronary symdrome, and it was worthy clinical application.
基金Hubei Natural Science Foundation Project(2013CKB005).
文摘Objective:To investigate the effect of tironon on inflammatory factors, endothelial function and cardiac function after interventional therapy in AMI patients.Methods:A total of 120 patients with acute myocardial infarction in our hospital were selected as the research objects, all of them were in line with the indications of PCI operation. They were randomly divided into the observation group (60 cases) and the control group (60 cases). The control group was treated with aspirin and clopidogrel before and after PCI, and the observation group was treated with based on the use of tirofiban. Inflammatory factors, endothelial function and cardiac function index were detected and compared between the two groups.Results: Before treatment, there was no significant difference in hs-CRP, sCD40L and TNF-alpha levels in the two groups. After treatment, the hs-CRP of the two groups were (5.01±1.95) mg/L, (9.41±2.48) mg/L, sCD40L were (1.88±0.25) ng/mL, (2.77±0.27) ng/mL, TNF-α were (8.86±2.18) ng/L, (15.52±2.78) ng/L, respectively. The levels of hs-CRP, sCD40L and TNF-α in the two groups were all decreased, and the level of each index in the observation group was lower than that of the control group. There was no significant difference in NO, ET-1 and vWF levels between the two groups before treatment. After treatment, the NO of the two groups were (82.48±11.57) umol/L and (66.68±13.18) umol/L, respectively. The two groups of NO were all elevated, and the NO of the observation group was higher than that of the control group. After treatment, the ET-1 of the two groups were (55.03±6.58) ng/L, (66.17±5.42) ng/L, and vWF were (66.17±5.88)×10-2, (83.28±5.39)×10-2, respectively. The ET-1 and vWF of the two groups were all decreased, and the ET-1 and vWF of the observation group were lower than those of the control group. There was no significant difference in LVEF, LVESD and LVEDD between the two groups before treatment. After treatment, the LVEF, LVESD and LVEDD of the observation group were (63.87±6.43)%, (38.27±4.66) mm and (43.63±7.61) mm, respectively. The LVEF of the observation group was higher than that of the control group, and the LVESD and LVEDD were lower than that of the control group.Conclusion: Tirofiban can effectively improve the inflammatory factors, endothelial function and cardiac function of AMI patients after interventional therapy.
文摘Objective:To evaluate the efficacy and safety of tirofiban hydrochloride in the treatment of ischemic stroke with thrombolytic therapy.Method:Two hundred patients with acute ischemic stroke thrombolysis were randomly divided into the experimental group and the control group.The experimental group was given tirofiban with the addition of rtpa in the control group and the therapeutic effects of the two groups were compared.Results:In comparison with the control group,the NIHSS improvement rate was 98%in the experimental group within 14 days.The platelet aggregation rate and efficacy in the experimental group were significantly reduced than the control group(P<0.01).The major adverse reaction in the two groups was hemorrhage with an incidence rate of 3%.Conclusion:Tirofiban hydrochloride is a highly effective and selective platelet glycoprotein Ⅱb/Ⅲa receptor inhibitor,which is safe and effective in combination with heparin and aspirin.
文摘Objective: To compare the effect of intracoronary arterial injection of tirofiban and sodium nitroprusside (SNP) on no-reflow phenomenon in patients with acute ST-segment elevation myocardial infarction (STEMI) underwent primary percutaneous coro-nary intervention (PCI). Methods: A total of 68 patients with acute STEMI who had no-reflow phenomenon during PCI were chosen and randomly divided into SNP group (n = 34) and tirofiban group (n = 34). Aiming at no-reflow phenomenon during PCI, with the use of microcatheters, intracoronary arterial injection of tirofiban was given in tirofiban group, while intracoronary bolus of SNP was given in SNP group. Coronary angiography was conducted to record TIMI flow grade of the infarct-related artery after 10 minutes. Plasma brain natriuretic peptide (BNP) was monitored before and after PCI (in 24 hours). With the help of ultrasound cardiogram, left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD) and left ventricular end-systolic dimension (LVESD) were recorded and compared in 30 days after PCI. Results: The ratio of TIMI grade 3 blood flow in tirofiban group was significantly higher than that in SNP group (76.5% (26/34) vs. 52.9% (18/34), p = .03)BNP levels in two groups had no statistical significance before PCI (p = .16), but in 24 h after PCI, BNP levels in tirofiban group were significantly lower than those in SNP group ((439.00 ± 4.90) μmol/L vs. (632.00 ± 3.63) μmol/L, p = .02)In 30 days after PCI, LVEF, LVEDD and LVESD in tirofiban group were all superior to those in SNP group (all p < .05). Conclusions: Intracoronary arterial injection of tirofiban was superior to SNP in improving no-reflow phenomenon in STEMI patients after PCI in the emergency treatment. Tirofiban therapy can increase coronary blood flow and myocardial perfusion after the occurrence of no-reflow phenomenon during PCI in STEMI patients, and improve long-term prognosis.
文摘Objective:To observe the influence of tirofiban on the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI and provide scientific basis for treatment of acute myocardial infarction.Methods:A total of 100 cases of hypertensive cerebral hemorrhage patients in our hospital were selected and randomly divided into 2 groups: the control group (50 cases) and the observation group (50 cases). The conventional treatment of PCI was performed on both groups. Tirofiban injection was given to the observation group on the basis of conventional treatment. cTnI, BNP and echocardiography parameters (LVEF, LVEDD, LVESD) were detected before and after treatment.Results:The comparison of cTnI in the two groups before operation was not statistically significant. cTnI in the 2 groups increased 12 h and 24 h after operation. But the cTnI in observation group (0.10±0.23) ng/mL decreased more significantly than that in control group (0.24±0.31) ng/mL, the difference was considered to be statistically significant. The comparison of BNP in the two groups before operation was not statistically significant. BNP in the 2 groups decreased obviously 7 d and 30 d after operation. BNP in observation group decreased more significantly than that in control group and the difference was considered to be statistically significant LVEF in the observation group increased significantly compared with that in control group 7 d after operation. The comparison of LVEDD, LVESD were not considered to be statistically significant. LVEDD and LVESD in the observation group were lower than that in control group obviously 30 d after operation. While the LVEF in the observation group was still higher than that in the control group. The comparsion was considered to be statistically significant.Conclusion:Tirofiban can improve the troponin, brain natriuretic peptide, heart function in patients with Acute Myocardial Infarction after PCI. It can also decrease the heart injury as well as helping the recovery of heart function.
文摘To evaluate the safety and efficacy of tirofiban, a specific inhibitor of the platelet glyco- protein Ⅱb/Ⅲa receptor, in the treatment of unstable angina and myocardial infarction without per- sistent ST elevation (acute coronary syndrome, ACS), a total of 200 patients were randomly assigned to a heparin group and a tirofiban+heparin group on double-blind basis and the treatment effects of the two protocols on ACS were compared when the patients of both groups were taking aspirin at the same time. The composite primary end-point events consisted of death, myocardial infarction, or re- fractory ischemia. Our results showed that the frequency of the composite primary end point events in 30 days was lower in tirofiban+heparin group as compared with that of heparin group (13.9% vs 29.3 %, P=0.010). The rates of the other composite end point events in the tirofiban+heparin group were also lower than those in the heparin group in 4.5 days and in 30 days. Bleeding complication occurred in 7.0% of the patients receiving heparin alone and in 12.7% of the patients receiving tirofiban and heparin in combination (P=0.1717). The study showed that the incidence of ischemic events in pa- tients with ACS receiving tirofiban+heparin was lower when compared with that of patients who re- ceived only heparin and aspirin, suggesting that tirofiban might be of special value in the treatment of ACS.
基金supported by a grant from ShenZhen Hybio Engineering Co.,Ltd.
文摘Objective: To compare clinical outcomes and safety of eptifibatide or tirofiban in patients with acute coronary syndrome(ACS) undergoing percutaneous coronary intervention(PCI). Methods:Thirty-six patients with ACS(unstable angina/non-ST-segment elevation myocardial infarction, UA/NSTEMI) who underwent PCI were randomly divided into two groups to receive eptifibatide or tirofiban treatment. Eptifibatide or tirofiban was predominantly initiated in the catheter laboratory before the intervention. In-hospital and 30-day MACE outcomes; bleeding as well as platelet counting were investigated in those two groups. Results:No in-hospital and 30-day MACE event occurred in the two groups. The number of ischemia leads after treatment reduced compared to that before PCI in the two groups. There was improvement in the number of ischemia leads for 24 h after administration in the tirofiban group than those in eptifibatide group(4.21±2.46 vs. 3.89±3.31, P =0.03). The two groups showed no incidence of massive bleeding. Minor bleeding rates were 16.7% and 22.2% in the two groups respectively. Conclusion:Eptifibatide as an adjunct to PCI may further decrease the incidence of ischemia event in patients with ACS and improve the safety, but its long-term efficacy and side effects need further observation.
