Combined Approach to Eptifibatide and Thrombectomy in Acute Ischemic Stroke Because of Large Vessel Occlusion: A Matched-Control Analysis
Gaoting Ma, Xuan Sun, Huiran Cheng, W. Scott Burgin, Weiliang Luo, Weihua Jia, Yajie Liu, Wenlong He, Xiaokun Geng, Liangfu Zhu, Xingyu Chen, Huaizhang Shi, Haowen Xu, Litong Zhang, Anxin Wang, Dapeng Mo, Ning Ma, Feng Gao, Ligang Song, Xiaochuan Huo, Yiming Deng, Lian Liu, Gang Luo, Baixue Jia, Xu Tong, Liping Liu, Zeguang Ren, Zhongrong Miao, Liqiang Gui, Tianyu Wang, Xiang Ma, Chunshui Yang, Liqiang Gui, Cunfeng Song, Ya Peng, Jin Wu, Shijun Zhao, Junfeng Zhao, Zhiming Zhou, Yongli Li, Ping Jing, Lei Yang, Qingshi Zhao, Yan Liu, Xiaoxiang Peng, Qingchun Gao, Zaiyu Guo, Wenhuo Chen, Weirong Li, Xiaojiang Cheng, Yun Xu, Yongqiang Zhang, Guilian Zhang, Yijiu Lu, Xinyu Lu, Dengxiang Wang, Yan Wang, Hao Li, Yang Hua, Deqin Geng, Haicheng Yuan, Hongwei Wang, Haihua Yang, Zengwu Wang, Liping Wei, Xuancong Liufu, Xiangqun Shi, Juntao Li, Wenwu Yang, Wenji Jing, Xiang Yong, Leyuan Wang, Chunlei Li, Yibin Cao, Qingfeng Zhu, Peng Zhang, Xiang Luo, Shengli Chen, WenWu Peng, Lixin Wang, Xue Wen, Shugui Shi, Wanming Wang, Wang Bo, Pu Yuan, Dong Wang, Haitao Guan, Wenbao Liang, Daliang Ma, Long Chen, Yan Xiao, Xiangdong Xie, Zhonghua Shi, Xiangjun Zeng, Fanfan Su, MingZe Chang, Jijun Yin, Hongxia Sun, Chong Li, Yong Bi
Abstract
BACKGROUND: In patients undergoing mechanical thrombectomy (MT), adjunctive antithrombotic might improve angiographic reperfusion, reduce the risk of distal emboli and reocclusion but possibly expose patients to a higher intracranial hemorrhage risk. This study evaluated the safety and efficacy of combined MT plus eptifibatide for acute ischemic stroke. METHODS: This was a propensity-matched analysis of data from 2 prospective trials in Chinese populations: the ANGEL-ACT trial (Endovascular Treatment Key Technique and Emergency Workflow Improvement of Acute Ischemic Stroke) in 111 hospitals between November 2017 and March 2019, and the EPOCH trial (Eptifibatide in Endovascular Treatment of Acute Ischemic Stroke) in 15 hospitals between April 2019 and March 2020. The primary efficacy outcome was good outcome (modified Rankin Scale score 0-2) at 3 months. Secondary efficacy outcomes included the distribution of 3-month modified Rankin Scale scores and poor outcome (modified Rankin Scale score 5-6) and successful recanalization. The safety outcomes included any intracranial hemorrhage, symptomatic intracranial hemorrhage, and 3-month mortality. Mixed-effects logistic regression models were used to account for within-hospital clustering in adjusted analyses. RESULTS: =0.016). No significant difference was found in the remaining outcome measures between the 2 groups. All outcome measures of propensity score matching were consistent with mixed-effects logistic regression models in the total population. CONCLUSIONS: This matched-control study demonstrated that MT combined with eptifibatide did not raise major safety concerns and showed a trend of better efficacy outcomes compared with MT alone. Overall, eptifibatide shows potential as a periprocedural adjunctive antithrombotic therapy when combined with MT. Further randomized controlled trials of MT plus eptifibatide should be prioritized. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT03844594 (EPOCH), NCT03370939 (ANGEL-ACT).