Safety of GPⅡb/Ⅲa receptor antagonist tirofiban in elderly patients with acute ischemic stroke

Background While tirofiban is established as a safe and effective treatment for acute ischemic stroke, its safety and efficacy in very elderly patients (≥ 75 years old) remain less defined. This exploratory retrospective study aimed to investigate whether the safety and functional outcomes of tirofiban in elderly patients (≥ 75 years old) differ from those in non-elderly patients (< 75 years old) with acute ischemic stroke. Methods This single-center retrospective study included 150 patients with acute ischemic stroke treated in Zhengzhou Central Hospital Affiliated to Zhengzhou University between January 2022 and June 2024. They were divided into an elderly group (46 patients, ≥ 75 years) and a non-elderly group (104 patients, < 75 years). Basic information was collected from both groups. The National Institutes of Health Stroke Scale (NIHSS) scores, modified Rankin Scale (mRS) scores, and bleeding rates after medication (moderate to severe symptomatic intracranial hemorrhage, asymptomatic intracranial hemorrhage, gum bleeding, skin and mucous membrane bleeding, gastrointestinal bleeding, urinary bleeding, other bleeding) were compared between groups before treatment, after treatment, at discharge, and at 90 days. The primary efficacy outcome was the change in NIHSS and mRS scores from baseline to 90 days. Drug safety was evaluated by comparing bleeding rates and mortality rates. Because of the limited sample size and baseline imbalances between groups, efficacy and safety comparisons were unadjusted, and the findings should be regarded as exploratory. Results There were no significant differences between the two groups in the change of NIHSS scores (median ΔNIHSS at 90 days: 4.0 vs. 3.0, P = 0.663) or mRS scores (median ΔmRS at 90 days: 1.0 vs. 1.0, P = 0.199) from baseline to 90 days. The incidence of any bleeding events was comparable between the elderly and non-elderly groups (19.6% vs. 9.6%, P = 0.091), although the numerically higher total bleeding rate in the elderly group warrants caution and confirmation in larger studies. No deaths occurred in either group. In an exploratory subgroup analysis of patients with onset-to-treatment (OTT) time < 8 h, both groups showed similar improvements in NIHSS and mRS scores at 90 days. Conclusions In this exploratory single-center retrospective study, tirofiban use in elderly patients (≥ 75 years) with acute ischemic stroke was not associated with a statistically significant increase in bleeding events or mortality in unadjusted comparisons. However, because of the retrospective design, limited number of elderly patients, and baseline differences between groups, these findings do not establish equivalence or definitive safety/efficacy. Age alone should not necessarily preclude the use of tirofiban, but prospective randomized studies with adequate adjustment for confounders are needed. Trial registration Not applicable.