• Mario Zanaty, Carlos Osorno-Cruz, Stefano Byer, Jorge A Roa, Kaustubh Limaye, Daizo Ishii, Daichi Nakagawa, James Torner, Lu Yongjun, Santiago Ortega-Gutiérrez, Edgar A Samaniego, Lauren Allan, and David Hasan.
• Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
• Neurosurgery. 2020 Oct 15; 87 (5): E552-E556.

BackgroundThere has not been any effective prophylaxis for delayed cerebral ischemia delayed cerebral ischemia (DCI) since the introduction of nimodipine. Platelet inhibition may reduce the risk by preventing the formation of microthrombi. Tirofiban has been used as a single monotherapy bridge given its safety profile and controlled platelet inhibition.ObjectiveTo assess the risk of DCI in aneurysmal subarachnoid hemorrhages (aSAH) patients treated with the tirofiban protocol.MethodsaSAH patients between December 2010 and March 2019 who were treated with stent assisted coiling or flow-diverting device were started on a continuous tirofiban infusion protocol and were compared with patients who underwent coil embolization without antiplatelet therapy. Safety analysis was performed to assess DCI, hemorrhagic, and ischemic events.ResultsA total of 21 patients were included in the tirofiban series and 81 in the control group. There was no statistical difference in age, gender, Hunt-Hess grade, and Fisher scale between the 2 groups except for a higher Fisher grade II in the tirofiban group. Multivariate analysis revealed tirofiban to reduce the risk of vasospasm by 72 percent (OR .28, P = .03), without affecting the risk of hemorrhagic complications (OR = 0.50, P = .26). Tirofiban reduced the risk of symptomatic stroke endovascular procedure but it did not reach significance (P = .06). DCI, older age, and postprocedural symptomatic stroke were significant predictors of mortality. Tirofiban reduced the mortality risk, but this association was not statistically significant.ConclusionThe tirofiban protocol in aSAH patients reduces the risk of DCI without conferring additional risks. This supports previous findings were antiplatelet therapy reduced DCI in human and animal models.Copyright © 2020 by the Congress of Neurological Surgeons.

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