Clinical outcomes and bleeding events associated with tirofiban combined with intravenous alteplase in acute ischaemic stroke: a retrospective single-center study

Objective To evaluate the clinical efficacy and bleeding risk of tirofiban combined with intravenous alteplase in patients with acute ischaemic stroke (AIS). Methods This retrospective study identified 90 AIS patients who were divided according to the treatment received into a combined group (CG, n = 45; tirofiban plus alteplase) and an alteplase group (AG, n = 45; alteplase alone). The 90-day modified Rankin Scale outcome was defined as the primary outcome, whereas neurological deficits, coagulation parameters, inflammatory biomarkers, post-treatment vascular status, activities of daily living, and bleeding events were evaluated as secondary or exploratory outcomes. Results Baseline characteristics were comparable between the two groups ( p > 0.05). NIHSS scores in the CG were significantly lower than in the AG at 24 h, 7 days, and 14 days after treatment (all p < 0.01). Post-treatment PT, APTT, and D-dimer were higher in the CG, while fibrinogen was lower (all p < 0.001). At day 7, hs-CRP, IL-6, and TNF- α were significantly lower in the CG (all p < 0.001). The CG had a higher rate of favorable post-treatment vascular status ( χ 2 = 4.731, p = 0.030), a higher proportion of favorable 90-day outcomes defined as mRS ≤ 2 ( χ 2 = 5.414, p = 0.020), and higher Barthel Index scores at day 14 ( p < 0.001). The total bleeding rate was 28.89% in the CG and 17.78% in the AG, with no statistically significant between-group difference ( χ 2 = 1.543, p = 0.214). Conclusion In this retrospective single-center cohort, tirofiban combined with alteplase was associated with lower NIHSS scores, better post-treatment vascular status, and higher rates of favorable 90-day outcomes, suggesting that combination therapy may potentially improve neurological recovery, attenuate inflammation, and optimize post-treatment vascular status in patients with AIS; however, these findings require confirmation in larger randomized trials.