Tirofiban combined with human urinary kallidinogenase for acute isolated brainstem infarction with early neurological deterioration: comparison with tirofiban alone
10.3760/cma.j.issn.1673-4165.2025.07.003
- VernacularTitle:替罗非班与人尿激肽原酶联合治疗发生早期神经功能恶化的急性孤立性脑干梗死：与单用替罗非班的比较
- Author:
Meijuan YAN
1
;
Lihui SHAO
Author Information
1. 徐州医科大学附属市立医院神经内科，徐州 221100
- Keywords:
Brain stem infarctions;
Ischemic stroke;
Tirofiban;
Fibrinolytic agents;
Tissue kallikreins;
Treatment outcome
- From:
International Journal of Cerebrovascular Diseases
2025;33(7):515-522
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy and safety of tirofiban combined with human urinary kallidinogenase (HUK) in the treatment of acute isolated brainstem infarction (AIBI) with early neurological deterioration (END).Methods:Consecutive patients with AIBI complicated with END admitted to Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University within 24 hours of symptom onset from April 2017 to October 2022 were included retrospectively. The patients were divided into a tirofiban group and a combined therapy group. In the tirofiban group, tirofiban was administered via intravenous infusion for 48 hours within 2 hours after END, followed by dual antiplatelet therapy with aspirin and clopidogrel 4 hours before discontinuation of tirofiban. The combined therapy group received HUK treatment in addition to tirofiban. The primary outcome was assessed using the modified Rankin Scale at 3 months after onset, and a score ≤2 was defined as good outcome. The secondary outcome measures included all adverse events during the treatment and follow-up. The clinical data were collected, and univariate and multivariate logistic regression was used to analyze the efficacy and safety of tirofiban combined with HUK. Results:A total of 256 patients with AIBI complicated with END were included. The median age was 64 (interquartile range, 56-71) years, and 185 patients were males (72.27%). One hundred and eighteen patients (46.09%) received combined treatment, and 138 (53.91%) received tirofiban alone; 165 (64.45%) had good outcome, and 91 (35.55%) had poor outcome. There was no significant difference in demographic baseline data between the combined therapy group and the tirofiban group. The rate of good outcome at 90 days after onset in the combined treatment group was significantly higher than that in the tirofiban group (72.03% vs. 57.97%; χ 2=5.491, P=0.019), but there were no significant differences in the incidence of symptomatic intracranial hemorrhage, asymptomatic hemorrhagic transformation, mortality within 90 days, and serious adverse events. Multivariate logistic regression analysis showed that the combined therapy was an independent protective factor for good outcome (odds ratio 0.388, 95% confidence interval 0.224-0.672; P<0.001), while diabetes was an independent risk factor for poor outcome (odds ratio 1.530, 95% confidence interval 1.313-1.784; P<0.001). Conclusion:Early combined use of tirofiban and HUK therapy can effectively improve the outcome of patients with AIBI complicated with END, and has good safety.
