The safety and efficacy of a low dose of tirofiban for early complications during and after stent-assisted coiling of ruptured intracranial aneurysms: A propensity matching study

Purpose: During stent-assisted coiling of ruptured intracranial aneurysms (RIA), appropriate antiplatelet administration is an important element of management. We aimed to evaluate the safety and efficacy of intra-venous tirofiban administration versus dual antiplatelet therapy (DAPT) for stent-assisted coiling of RIAs within 24 h after procedure.Methods: From January 2015 to March 2019, two groups of patients with RIAs treated with stent-coiling were compared: the DAPT group (a loading dose of 300 mg clopidogrel and 300 mg aspirin) and the tirofiban group (intravenous administration of tirofiban 5 mu g/kg over 1 min, followed by a maintenance dose of 0.1 mu g/kg/min). The main outcome measures were rates of ischemic events and intracranial hemorrhage. Propensity score-matching (PSM) analysis was performed to correct imbalances in patient characteristics between the two groups.Results: A total of 200 patients with RIAs were identified, with 36 patients in DAPT group and 164 in tirofiban group. After PSM, 36 patients in DAPT group and 72 patients in tirofiban group were matched. Ischemic events were noted for 8.33% (3/36) of patients in DAPT group, and 4.17% (3/72) in tirofiban group within 24 h after procedure(P = 0.398). Intracranial hemorrhage was noted for 0.00% (0/36) of patients in DAPT group, and 1.39% (1/72) in tirofiban group (P = 1.000) within 24 h. And no significant difference in the rate of ischemic or hemorrhagic events after 24 h was detected.Conclusions: Intravenous administration of a low dose of tirofiban may represent a safe and effective alternative to DAPT during stent-assisted coiling of RIAs.