Thrombolysis with recombinant tissue plasminogen activator and tirofiban in stroke: preliminary observations.
OBJECTIVE
We sought to investigate the feasibility of the combined use of low-dose recombinant tissue plasminogen activator (rtPA) and tirofiban, a glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonist, for systemic thrombolysis in acute stroke.


METHODS
Consecutive patients who were treated with systemic application of low-dose rtPA and body weight-adjusted tirofiban (rtPA+T group; n=37) were evaluated retrospectively during 1999-2001. Patients in the rtPA+T group were compared with a group of patients treated with a dose of 0.9 mg/kg body weight in a different center (rtPA group; n=119). The 41 patients with infarctions of the middle cerebral artery territory who were not eligible for thrombolytic treatment because of medical contraindications or arrival in the hospital >3 hours after stroke onset served as controls. For matched comparisons, the National Institutes of Health Stroke Scale on admission and the Rankin Scale on discharge 5 days after stroke were used.


RESULTS
The patients treated with rtPA+T or rtPA improved (P<0.05) compared with the controls at discharge; patients in the rtPA+T and rtPA groups reached a Rankin Scale score of 0 to 2 in 63% and 55%, respectively, while only 16% of the controls achieved this score. Death rates (8% in rtPA+T group and 5% in rtPA group) were similar among the 2 treatment groups. They included 1 fatal hemorrhage in the rtPA+T group and 4 fatal hemorrhages in the rtPA group. Five percent of the untreated patients developed symptomatic, nonfatal cerebral hemorrhage.


CONCLUSIONS
Systemic combined thrombolysis with rtPA+T seems to be a feasible treatment in acute stroke.
Seitz
Rüdiger J
RJ
Department of Neurology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. seitz@neurologie.uni-duesseldorf.de
Hamzavi
Magnolia
M
Junghans
Ulrich
U
Ringleb
Peter A
PA
Schranz
Corinna
C
Siebler
Mario
M
D000208:Acute Disease; D000368:Aged; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D010865:Pilot Projects; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D000077466:Tirofiban; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives
D005343:Fibrinolytic Agents; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D014443:Tyrosine; D010959:Tissue Plasminogen Activator; D000077466:Tirofiban