Tirofiban After Acute Ischemic Stroke Eases Early Neurological Deterioration

Intravenous tirofiban decreased the risk of early neurological deterioration in patients with acute noncardioembolic stroke without an increased risk of symptomatic intracerebral hemorrhage or systematic bleeding, according to study results published in JAMA Neurology.

“Evidence supports using antiplatelet therapy in patients with acute ischemic stroke. However, neurological deterioration remains common under the currently recommended antiplatelet regimen, leading to poor clinical outcomes,” wrote first author Wenbo Zhao, MD, of Xuanwu Hospital, Capital Medical University, Beijing, China, and study coauthors in the study background.

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To investigate the effect of intravenous tirofiban, a potent antiplatelet agent, administered within 24 hours of stroke onset, researchers initiated an open-label, multicenter trial at 10 stroke centers in China between September 2020 and March 2023. A total of 425 patients were randomized 1:1 to either intravenous tirofiban or oral aspirin for 72 hours. Afterward, all patients received oral aspirin. Patients in the study ranged from 56 to 71 years; the median age was 64 years.

The proportion of patients with early neurological deterioration, defined as a 4-point or higher increase in the National Institutes of Health Stroke Scale score, was 4.2% in the tirofiban group and 13.2% in the aspirin group. Researchers reported an adjusted relative risk of 0.32 for early neurologic deterioration with tirofiban.

No patients experienced symptomatic intracerebral hemorrhage, the study’s primary safety outcome, with tirofiban.

The 90-day mortality rate was 1.3% in the tirofiban group and 1.5% in the aspirin group, according to the study. Median modified Rankin scale scores at 90 days were 1.0 in the tirofiban group and 1.0 in the aspirin group.

“Given the safety and efficacy profiles of intravenous tirofiban in patients with acute noncardioembolic stroke, tirofiban could be used as a first-line antiplatelet drug to prevent early neurological deterioration,” researchers advised.

Reference

Zhao W, Li S, Li C, et al. Effects of tirofiban on neurological deterioration in patients with acute ischemic stroke: a randomized clinical trial. JAMA Neurol. Published online April 22, 2024. doi: 10.1001/jamaneurol.2024.0868