Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ASCO Annual Meeting 2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

2024 ASCO Annual Meeting

Keep up to date with all the top stories and latest evidence with our hub page, including official congress videos and expert takeaways.
ADVANCED SEARCH
Log in
Top
Clinical Neuroradiology
Published in: Clinical Neuroradiology 2/2023

Open Access 21-10-2022 | Tirofiban | Original Article

Safety Profile and Complication Rates in Emergency Off-label Use of Tirofiban in Interventional Neuroradiology

An Observational Dual Center Study

Authors: Carolin Brockmann, Daniel Dillinger, Anastasios Mpotsaris, Annette Spreer, Volker Maus, Stephan Waldeck, Ahmed E. Othman, Sebastian Altmann, Florian Ringel, Thomas Kerz, Marc A. Brockmann

Published in: Clinical Neuroradiology | Issue 2/2023

Login to get access

Abstract

Purpose

Tirofiban has been approved for the treatment of acute coronary syndrome. Meanwhile, tirofiban is frequently applied in emergency situations in interventional neuroradiology (INR). The objective of this study was to analyze the risk profile for the off-label use of tirofiban in INR patients.

Methods

Data of 86 patients, who underwent neurointerventional therapy and were treated with tirofiban at 2 neuroendovascular centers between January 2016 and July 2017 were retrospectively analyzed. Despite off-label use, recent stroke (< 30 days), recent hemorrhage, thrombocytopenia (< 150,000/µl), activated partial thromboplastin time (aPTT) > 1.3-fold, internation normalised ratio (INR) < 1.5, severe liver insufficiency (Child-Pugh C), and preceding intravenous thrombolysis were considered as contraindications.

Results

Median patient age was 62 years (range 26–88 years). Patients received tirofiban for extracranial (n = 35) or intracranial stenting (n = 35), coiling of ruptured cerebral aneurysms (n = 6), continuous intra-arterial nimodipine infusion via microcatheters for subarachnoid hemorrhage (SAH)-related vasospasm (n = 5), or thrombotic complications during neuroendovascular procedures (n = 5). The desired effect of preventing thrombotic complications when applying tirofiban off-label was achieved in 81 of 86 patients (94.2%). Relevant tirofiban-associated complications occurred in 14 patients (16.3%), of which 9 patients received i.v. thrombolysis for treatment of acute ischemic stroke shortly before starting therapy with tirofiban. Of the 86 patients 12 died, while the overall tirofiban-related mortality was 2.3% (2 patients died due to ICH). Logistic regression analysis revealed age to be the only parameter significantly associated with development of tirofiban-associated complications (p = 0.026).

Conclusion

Whereas the safety profile of tirofiban when applied off-label in INR is acceptable, the highest risk for relevant tirofiban-associated complications is observed in older patients treated by emergency stenting for acute stroke.
Literature
1.
Kramer A, Selbach M, Kerz T, Neulen A, Brockmann MA, Ringel F, Brockmann C. Continuous Intraarterial Nimodipine Infusion for the Treatment of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage: A Retrospective, Single-Center Cohort Trial. Front Neurol. 2022;13:829938.CrossRefPubMedPubMedCentral
2.
Pearce S, Maingard JT, Kuan Kok H, Barras CD, Russell JH, Hirsch JA, Chandra RV, Jhamb A, Thijs V, Brooks M, Asadi H. Antiplatelet Drugs for Neurointerventions: Part 2 Clinical Applications. Clin Neuroradiol. 2021;31:545–58.CrossRefPubMed
3.
Pearce S, Maingard JT, Li K, Kok HK, Barras CD, Russell JH, Hirsch JA, Chandra RV, Jhamb A, Thijs V, Brooks M, Asadi H. Antiplatelet Drugs for Neurointerventions: Part 1 Clinical Pharmacology. Clin Neuroradiol. 2020;30:425–33.CrossRefPubMed
4.
Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. N Engl J Med. 1998;338:1488–97. Erratum in: N Engl J Med 1998;339:415.CrossRef
5.
Bolognese L, Falsini G, Liistro F, Angioli P, Ducci K, Taddei T, Tarducci R, Cosmi F, Baldassarre S, Burali A. Randomized comparison of upstream tirofiban versus downstream high bolus dose tirofiban or abciximab on tissue-level perfusion and troponin release in high-risk acute coronary syndromes treated with percutaneous coronary interventions: the EVEREST trial. J Am Coll Cardiol. 2006;47:522–8.CrossRefPubMed
6.
Chalouhi N, Jabbour P, Daou B, Starke RM, Shields B, Hasan DM. A New Protocol for Anticoagulation With Tirofiban During Flow Diversion. Neurosurgery. 2016;78:670–4.CrossRefPubMed
7.
Siebler M, Hennerici MG, Schneider D, von Reutern GM, Seitz RJ, Röther J, Witte OW, Hamann G, Junghans U, Villringer A, Fiebach JB. Safety of Tirofiban in acute Ischemic Stroke: the SaTIS trial. Stroke. 2011;42:2388–92.CrossRefPubMed
8.
Seitz RJ, Hamzavi M, Junghans U, Ringleb PA, Schranz C, Siebler M. Thrombolysis with recombinant tissue plasminogen activator and tirofiban in stroke: preliminary observations. Stroke. 2003;34:1932–5.CrossRefPubMed
9.
Seitz RJ, Sukiennik J, Siebler M. Outcome after systemic thrombolysis is predicted by age and stroke severity: an open label experience with recombinant tissue plasminogen activator and tirofiban. Neurol Int. 2012;4:e9.CrossRefPubMedPubMedCentral
10.
Torgano G, Zecca B, Monzani V, Maestroni A, Rossi P, Cazzaniga M, Manganaro D, Boiti C, Zilioli E, Borutti G, Falaschi F, Mandelli C. Effect of intravenous tirofiban and aspirin in reducing short-term and long-term neurologic deficit in patients with ischemic stroke: a double-blind randomized trial. Cerebrovasc Dis. 2010;29:275–81.CrossRefPubMed
11.
Junghans U, Seitz RJ, Aulich A, Freund HJ, Siebler M. Bleeding risk of tirofiban, a nonpeptide GPIIb/IIIa platelet receptor antagonist in progressive stroke: an open pilot study. Cerebrovasc Dis. 2001;12:308–12.CrossRefPubMed
12.
Kellert L, Hametner C, Rohde S, Bendszus M, Hacke W, Ringleb P, Stampfl S. Endovascular stroke therapy: tirofiban is associated with risk of fatal intracerebral hemorrhage and poor outcome. Stroke. 2013;44:1453–5.CrossRefPubMed
13.
Lee D, Lee DH, Park JC, Shin JH, Song Y, Chung J, Sheen JJ, Suh DC. Timing of Thrombosis in Embolization of Unruptured Intracranial Aneurysms : Tirofiban as Rescue Treatment. Clin Neuroradiol. 2021;31:125–33.CrossRefPubMed
14.
Caroff J, Aubert L, Lavenu-Bombled C, Figueiredo S, Habchi K, Cortese J, Eugene F, Ognard J, Tahon F, Forestier G, Ifergan H, Zhu F, Hak JF, Reyre A, Laubacher M, Traore A, Desilles JP, Derraz I, Moreno R, Bintner M, Charbonnier G, Le Bras A, Veunac L, Gariel F, Redjem H, Sedat J, Tessier G, Dumas V, Gauberti M, Chivot C, Consoli A, Bricout N, Tuilier T, Guedon A, Pop R, Thouant P, Bellanger G, Zannoni R, Soize S, Richter JS, Heck O, Mihalea C, Burel J, Girot JB, Shotar E, Gazzola S, Boulouis G, Kerleroux B; JENI Research Collaboration. Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey. J Neurointerv Surg. 2022; https://​doi.​org/​10.​1136/​neurintsurg-2021-018601. Epub ahead of print.
15.
Correvio, Fachinformation (Zusammenfassung der Merkmale des Arzneimittels, SPC) Aggrastat 50 Mikrogramm/ml Infusionslösung. 2014.
16.
Behme D, Mpotsaris A, Zeyen P, Psychogios MN, Kowoll A, Maurer CJ, Joachimski F, Liman J, Wasser K, Kabbasch C, Berlis A, Knauth M, Liebig T, Weber W. Emergency Stenting of the Extracranial Internal Carotid Artery in Combination with Anterior Circulation Thrombectomy in Acute Ischemic Stroke: A Retrospective Multicenter Study. AJNR Am J Neuroradiol. 2015;36:2340–5.CrossRefPubMedPubMedCentral
17.
Kim S, Choi JH, Kang M, Cha JK, Huh JT. Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms. AJNR Am J Neuroradiol. 2016;37:508–14.CrossRefPubMedPubMedCentral
18.
Mangiafico S, Cellerini M, Nencini P, Gensini G, Inzitari D. Intravenous glycoprotein IIb/IIIa inhibitor (tirofiban) followed by intra-arterial urokinase and mechanical thrombolysis in stroke. AJNR Am J Neuroradiol. 2005;26:2595–601.PubMedPubMedCentral
19.
Mangiafico S, Cellerini M, Nencini P, Gensini G, Inzitari D. Intravenous tirofiban with intra-arterial urokinase and mechanical thrombolysis in stroke: preliminary experience in 11 cases. Stroke. 2005;36:2154–8.CrossRefPubMed
20.
Straub S, Junghans U, Jovanovic V, Wittsack HJ, Seitz RJ, Siebler M. Systemic thrombolysis with recombinant tissue plasminogen activator and tirofiban in acute middle cerebral artery occlusion. Stroke. 2004;35:705–9.CrossRefPubMed
21.
Bruder M, Schuss P, Konczalla J, El-Fiki A, Lescher S, Vatter H, Seifert V, Güresir E. Ventriculostomy-Related Hemorrhage After Treatment of Acutely Ruptured Aneurysms: The Influence of Anticoagulation and Antiplatelet Treatment. World Neurosurg. 2015;84:1653–9.CrossRefPubMed
22.
Hadler F, Singh R, Wiesmann M, Reich A, Nikoubashman O. Increased Rates of Hemorrhages after Endovascular Stroke Treatment with Emergency Carotid Artery Stenting and Dual Antiplatelet Therapy. Cerebrovasc Dis. 2021;50:162–70.CrossRefPubMed
23.
Lin YL, Chen LL, Luo YK, Zheng XC, Li WW. Benefit of standard versus low-dose tirofiban for percutaneous coronary intervention in very elderly patients with high-risk acute coronary syndrome. Acta Pharmacol Sin. 2009;30:553–8.CrossRefPubMedPubMedCentral
24.
Li W, Fu X, Xue H, Wang Y, Wang X, Zhao Y, Geng W, Yang Z, Gu X, Hao G, Jiang Y, Fan W, Wu W, Li S. Efficacy and safety of standard-dose versus half-dose tirofiban in patients with non-ST elevation acute coronary syndromes undergoing early percutaneous coronary intervention. Cardiovasc Ther. 2013;31:210–4.CrossRefPubMed
25.
Zhao H, Zhang J, Gu D, Shi Z, Pan J, Geng Y, Shi T. Tirofiban facilitates the reperfusion process during endovascular thrombectomy in ICAS. Exp Ther Med. 2017;14:3314–8.CrossRefPubMedPubMedCentral
Metadata
Title
Safety Profile and Complication Rates in Emergency Off-label Use of Tirofiban in Interventional Neuroradiology
An Observational Dual Center Study
Authors
Carolin Brockmann
Daniel Dillinger
Anastasios Mpotsaris
Annette Spreer
Volker Maus
Stephan Waldeck
Ahmed E. Othman
Sebastian Altmann
Florian Ringel
Thomas Kerz
Marc A. Brockmann
Publication date
21-10-2022
Publisher
Springer Berlin Heidelberg
Keywords
Tirofiban
Stroke
Published in
Clinical Neuroradiology / Issue 2/2023
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-022-01223-5

Other articles of this Issue 2/2023

Clinical Neuroradiology 2/2023 Go to the issue

Review Article

Cerebral Superficial Siderosis

Original Article

Exact Basilar Artery Occlusion Location Indicates Stroke Etiology and Recanalization Success in Patients Eligible for Endovascular Stroke Treatment

Correspondence

Endovascular Revascularization of an Unfavorable Type of Chronically Occluded Internal Carotid Artery Using a Balloon Guide Catheter

Correspondence

Medial Tentorial Meningeal Supply from the Collicular Artery

Original Article

Acute Intraprocedural Thrombosis After Flow Diverter Stent Implantation: Risk Factors and Relevance of Standard Observation Time for Early Detection and Management

Review Article

Computed Tomography of the Spine