Thrombolysis with Adjunctive Tirofiban in Acute Non-cardioembolic Posterior Circulation Ischemic Stroke: A Propensity Score-Matched Analysis

INTRODUCTION: This study aimed to compare clinical outcomes between recombinant tissue plasminogen activator plus tirofiban (rt-PA + T) and rt-PA alone in patients with acute non-cardioembolic posterior circulation ischemic stroke (APCIS) treated within 24 h. METHODS: In this retrospective, propensity score-matched cohort study, we analyzed data from patients with acute non-cardioembolic posterior circulation ischemic stroke. The intervention group (rt-PA + T) received standard-dose rt-PA followed by intravenous tirofiban, whereas the control group (rt-PA) received rt-PA alone. The primary outcome was a favorable functional outcome (modified Rankin Scale [mRS] 0-1) at 90 days. RESULTS: After propensity score matching, 256 patients (128 per group) were included in the final analysis. The proportion of patients achieving a favorable functional outcome (mRS 0-1) at 90 days was significantly higher in the rt-PA + T group than in the rt-PA group (63.3% vs. 50.0%; OR 1.72, 95% CI 1.05-2.84, P = 0.033). Functional independence (mRS 0-2) was also more common in the rt-PA + T group (73.4% vs. 60.9%; OR 1.77, 95% CI 1.04-3.01, P = 0.034). No significant differences were observed in symptomatic intracranial hemorrhage (1.6% vs. 0.0%, P = 0.498), any bleeding (6.3% vs. 5.5%, P = 0.454), or 90-day mortality (2.3% vs. 1.6%, P = 0.654). Subgroup analysis indicated greater benefit in patients with baseline NIHSS < 10 (P for interaction = 0.029). CONCLUSION: In patients with acute non-cardioembolic posterior circulation ischemic stroke treated within 24 h of onset, adjunctive tirofiban following standard intravenous thrombolysis was associated with significantly improved 90-day functional outcomes without a notable increase in major bleeding risk, particularly in patients with lower baseline NIHSS scores.