Scholarlink

Background <p>Early neurological deterioration (END) in patients with acute ischemic stroke (AIS) is a common phenomenon strongly associated with unfavorable outcomes. The TREND trial (NCT04491695) demonstrates the efficacy of intravenous tirofiban compared to oral aspirin in preventing END.</p> Aims <p>The purpose of this study was to explore whether prior antiplatelet therapy (APT) affected the therapeutic effects of tirofiban.</p> Methods <p>This prespecified post hoc analysis of the TREND trial stratified patients by prior antiplatelet use. The primary outcome was END<sub>4</sub> (≥ 4 points increase in National Institutes of Health Stroke Scale [NIHSS] within 72 h). Secondary outcomes included END<sub>2</sub> (≥ 2 points increase in NIHSS), early neurological improvement, 90-day functional outcomes, and safety events.</p> Results <p>Overall, 425 patients with AIS were analyzed, including 143 (33.6%) and 282 (66.4%) with and without prior APT, respectively. In patients without prior APT, tirofiban significantly reduced the risk of END<sub>4</sub> compared with aspirin (5.0% versus 14.2%; adjusted OR, 0.38; 95% CI 0.15–0.96; <i>P</i> = 0.040). Tirofiban was beneficial in reducing the risk of END₂ in both patients with (8.3% versus 22.5%, <i>P</i> = 0.020) or without prior APT (13.5% versus 24.1%; <i>P</i> = 0.032). There was no significant interaction between treatment and prior APT status (<i>P</i> for interaction &gt; 0.05). Further, no significant differences in 90-day functional outcomes or safety events were observed between the treatment groups for either antiplatelet status after adjustment.</p> Conclusions <p>Intravenous tirofiban significantly reduced the risk of END compared with aspirin in patients with AIS who were not on prestroke APT. Although this benefit was attenuated in pretreated patients, tirofiban might maintain a consistent efficacy and safety profile irrespective of prior antiplatelet use.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Impact of Prestroke Antiplatelet Therapy on the Efficacy of Intravenous Tirofiban at Preventing Early Neurological Deterioration: A Prespecified Subgroup Analysis of the TREND Trial

  • 期刊论文

  • 发表日期：

    2026年1月20日

查看全文
  • Jing Wang,
  • Yue Qiao,
  • Sijie Li,
  • Chuanhui Li,
  • Chuanjie Wu,
  • Xiaojun Hao,
  • Haiqing Song,
  • Qingfeng Ma,
  • Xunming Ji,
  • Longfei Wu,
  • Wenbo Zhao

摘要

Background

Early neurological deterioration (END) in patients with acute ischemic stroke (AIS) is a common phenomenon strongly associated with unfavorable outcomes. The TREND trial (NCT04491695) demonstrates the efficacy of intravenous tirofiban compared to oral aspirin in preventing END.

Aims

The purpose of this study was to explore whether prior antiplatelet therapy (APT) affected the therapeutic effects of tirofiban.

Methods

This prespecified post hoc analysis of the TREND trial stratified patients by prior antiplatelet use. The primary outcome was END4 (≥ 4 points increase in National Institutes of Health Stroke Scale [NIHSS] within 72 h). Secondary outcomes included END2 (≥ 2 points increase in NIHSS), early neurological improvement, 90-day functional outcomes, and safety events.

Results

Overall, 425 patients with AIS were analyzed, including 143 (33.6%) and 282 (66.4%) with and without prior APT, respectively. In patients without prior APT, tirofiban significantly reduced the risk of END4 compared with aspirin (5.0% versus 14.2%; adjusted OR, 0.38; 95% CI 0.15–0.96; P = 0.040). Tirofiban was beneficial in reducing the risk of END₂ in both patients with (8.3% versus 22.5%, P = 0.020) or without prior APT (13.5% versus 24.1%; P = 0.032). There was no significant interaction between treatment and prior APT status (P for interaction > 0.05). Further, no significant differences in 90-day functional outcomes or safety events were observed between the treatment groups for either antiplatelet status after adjustment.

Conclusions

Intravenous tirofiban significantly reduced the risk of END compared with aspirin in patients with AIS who were not on prestroke APT. Although this benefit was attenuated in pretreated patients, tirofiban might maintain a consistent efficacy and safety profile irrespective of prior antiplatelet use.