Abstract T MP81: Combination Therapy of Intravenous Glycoprotein IIb-IIIa Inhibitors and Low Dose Tissue Plasminogen Activator for Acute Ischemic Stroke
Introduction: Glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibitors block platelet aggregation following fibrinolysis. No phase III randomized clinical trial has assessed efficacy of combination therapy [Gp IIb/IIIa + IV tissue plasminogen activator (tPA)] to standard of care in acute ischemic stroke.
Aim: To conduct a retrospective pooled analysis of data from published prospective studies and randomized phase 1 and 2 trials, to assess efficacy and safety profile of IV combination therapy (Gp IIb/IIIa inhibitors and tPA) in management of acute ischemic stroke.
Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed and EMBASE databases, and 3 reviewers independently selected studies reporting safety endpoints and outcome measures in acute ischemic stroke patients treated with low dose tPA + eptifibatide. Demographic/ clinical variables: sex, age, NIH stroke scale (NIHSS) at presentation and Time-to-treatment, Safety endpoint: symptomatic intracranial hemorrhage (sICH), as well as outcome measures: Death at 90 days and modified Rankin score (mRS) 0-1 were consolidated into the two groups. tPA arm of the NINDS tPA trial was included in the tPA only group. Weighted means and proportions were calculated for numeric and categorical variables respectively. Bivariate analysis to compare baseline descriptors, safety endpoints and outcome measures consisted of Fisher’s exact test.
Results: 188 patients comprised the combination therapy arm, whereas the IV tPA arm had 218 patients. Mean NIHSS in the two groups were 12.8 and 14.6 respectively. Mean time-to-treatment was 2.3 hours in combination therapy arm and 2.55 hours in the tPA arm. Treatment with combination therapy was associated with a better functional outcome (mRS 0-1) (OR 1.79, 95% CI 1.15 - 2.80, p <0.01) at 90 days. There was also a significant reduction in the rate of sICH (OR 0.26, 95% CI 0.07 - 0.83) in the combination therapy group. Death at 90 days was not significantly different in the 2 groups (OR 1.26, 95% CI 0.73 - 2.18).
Conclusion: Combination of low dose IV tPA with Gp IIb/IIIa inhibitor is associated with a better functional outcome at 90 days, as well as a reduction in sICH rates in patients with acute ischemic stroke, as compared to 0.9g/kg IV tPA.
Author Disclosures: D. Dubey: None. C. Banerjee: None. A. Sawhney: None.
- © 2014 by American Heart Association, Inc.