Key result
Intravenous tirofiban before endovascular therapy in cardioembolic stroke patients did not improve 90-day functional outcomes (adjusted common OR 0.91) and significantly increased the risk of symptomatic intracranial hemorrhage.
Why the study?
The efficacy and safety of tirofiban in endovascular therapy for cardioembolic ischemic stroke patients remain controversial.
Does intravenous tirofiban improve functional outcomes at 90 days in patients with cardioembolic stroke undergoing endovascular therapy?
RCT (n=406)
Double-blind
1:1
Yes
Does intravenous tirofiban improve functional outcomes at 90 days in patients with cardioembolic stroke undergoing endovascular therapy?
Odds Ratio: 0.91 (95% CI 0.64–1.3)
p-value: p=0.617
Intravenous tirofiban prior to endovascular therapy in cardioembolic stroke does not improve functional outcomes and significantly increases the risk of symptomatic intracranial hemorrhage.
Tirofiban should be avoided before EVT in cardioembolic stroke due to higher sICH risk; post hoc analysis leaves open questions for other LVO etiologies.
BACKGROUND AND PURPOSE: The efficacy and safety of tirofiban in endovascular therapy for cardioembolic ischemic stroke patients remain controversial. This study aimed to evaluate the role of intravenous tirofiban before endovascular therapy in cardioembolic stroke. METHODS: This post hoc analysis utilized data from the RESCUE BT (Endovascular Treatment With versus Without Tirofiban for Patients with Large Vessel Occlusion Stroke) trial, which was an investigator-initiated, randomized, double-blind, placebo-controlled trial. Participants were randomized to receive either tirofiban or a placebo in a 1:1 ratio before undergoing endovascular therapy. The study included patients aged 18 years or older, presenting with occlusion of the internal carotid artery or middle cerebral artery (MCA) M1/M2 within 24 h of the last known well time, and with a stroke etiology of cardioembolism. The primary efficacy outcome was global disability at 90 days, assessed using the modified Rankin Scale (mRS). The safety outcome included symptomatic intracranial hemorrhage (sICH) within 48 h and mortality within 90 days. RESULTS: A total of 406 cardioembolic stroke patients were included in this study, with 212 assigned to the tirofiban group and 194 assigned to the placebo group. Tirofiban treatment did not correlate with a favorable shift towards a lower 90-day mRS score (adjusted common odds ratio [OR], 0.91; 95% CI 0.64-1.3; p = 0.617). However, the tirofiban group had a significantly higher risk of symptomatic intracranial hemorrhage (sICH) within 48 h (adjusted OR, 3.26; 95% CI 1.4-7.57; p = 0.006) compared to the placebo group. The adjusted odds ratio (aOR) for mortality within 90 days was 1.48 (95% CI 0.88-2.52; p = 0.143). CONCLUSIONS: Tirofiban treatment was not associated with a lower level of disability and increased the incidence of sICH after endovascular therapy in cardioembolic stroke patients.
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Rong et al. (2023) conducted an RCT in Cardioembolic ischemic stroke with large vessel occlusion (n=406). Tirofiban vs. Placebo was evaluated on Favorable shift towards a lower 90-day modified Rankin Scale (mRS) score (adjusted common OR 0.91, 95% CI 0.64-1.3, p=0.617). Intravenous tirofiban before endovascular therapy in cardioembolic stroke patients did not improve 90-day functional outcomes (adjusted common OR 0.91) and significantly increased the risk of symptomatic intracranial hemorrhage.
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