Therapeutic effect of tirofiban on patients with acute cerebral infarction after intravenous thrombolysis with alteplase

Wang Qian; Peng Xiao

doi:10.3969/j.issn.1672-8157.2025.01.032

Abstract：Objective To explore the effect of tirofiban on patients with acute cerebral infarction after intravenous thrombolysis with alteplase.Methods A total of 210 patients with acute cerebral infarction admitted to Handan First Hospital from May 2021 to January 2024 were selected as the research subjects.According to the different treatment regimens,the patients were divided into the thrombolysis group(intravenous thrombolysis with alteplase)and tirofiban group(tirofiban intravenous thrombolysis on the basis of thrombolysis group),with 105 in each group.The baseline data were excluded by propensity matching method.The clinical efficacy,neurological function(national institute of health stroke scale(NIHSS),Barthel index),coagulation indicators(fibrinogen(FIB),pro-thrombin time(PT)),cerebral blood flow indicators(cerebral artery mean flow velocity(Vm),peak systolic velocity(Vs),peak diastolic velocity(Vd))and serum related factors(insulin-like growth factor 1(IGF-1),brain-derived neurotrophic factor(BDNF),vascular endothelial growth factor(VEGF))and oxidative stress factors(glutathione peroxidase(GSH-Px),malonaldehyde(MDA),superox-ide dismutase(SOD))before and after treatment,adverse drug reactions and hemorrhagic transformation were compared between the two groups.Results The total efficacy in the tirofiban group(96.19%(101/105))was significantly higher than that in the thrombol-ysis group(88.57%(93/105))(χ2=4.330,P=0.037).After treatment,NIHSS in the tirofiban group and thrombolysis group was signifi-cantly decreased((7.63±1.10)points,(8.71±1.20)points)while Barthel index was significantly increased((73.92±6.58)points,(68.54±6.01)points)(all P<0.05),and NIHSS in tirofiban group was significantly lower than that in the thrombolysis group while Barthel in-dex was significantly higher(all P<0.05).FIB in the tirofiban group and thrombolysis group after treatment was significantly reduced((2.79±0.52)g·L-1,(3.45±0.62)g·L-1)while PT was significantly enhanced((15.59±3.01)s,(13.89±2.91)s)(all P<0.05),and FIB in tirofiban group was significantly lower but PT was significantly higher compared with the thrombolysis group(all P<0.05).The Vm,Vs and Vd in the tirofiban group and thrombolysis group were significantly increased((55.65±7.52)cm·s-1,(51.36±6.98)cm·s-1;(87.52±8.44)cm·s-1,(82.65±8.14)cm·s-1;(29.65±5.87)cm·s-1,(25.61±6.21)cm·s-1)(all P<0.05),and the tirofiban group had sig-nificantly higher Vm,Vs and Vd(all P<0.05).The levels of IGF-1,BDNF and VEGF were significantly elevated in the tirofiban group and thrombolysis group after treatment((145.95±24.10)μg·L-1,(134.37±22.21)μg·L-1;(9.21±1.51)μg·L-1,(7.89±1.36)μg·L-1;(74.52±6.30)μg·L-1,(71.26±5.27)μg·L-1)(all P<0.05),and the levels were significantly higher in the tirofiban group than those in the thrombolysis group(all P<0.05).MDA in the tirofiban group and thrombolysis group was declined significantly((5.21±0.78)mmol·L-1,(6.55±0.82)mmol·L-1)while GSH-Px and SOD were significantly enhanced((71.35±4.36)μmol·L-1,(64.93±5.04)μmol·L-1;(125.52±20.11)U·mL-1,(106.83±16.84)U·mL-1)(all P<0.05).Moreover,MDA in the tirofiban group was signifi-cantly lower(P<0.05)while GSH-Px and SOD were significantly higher as compared with the thrombolysis group(all P<0.05).The incidence of adverse drug reactions was 9.52%(10/105)in the tirofiban group and 5.71%(6/105)in the thrombolysis group(χ2=1.082,P=0.398).The drug hemorrhagic transformation rate was 8.57%(9/105)in the tirofiban group and 5.71%(6/105)in the thrombolysis group(χ2=0.646,P=0.421).Conclusion The application of tirofiban after intravenous thrombolysis with alteplase can effectively treat acute cerebral infarction to enhance neurological function and improve serum indicators.Meanwhile,it is of high safety.