Key result
Early tirofiban yields ~2.1-fold higher odds of excellent functional outcome in moderate-to-severe stroke.
Why the study?
The effects of admission stroke severity on the efficacy and safety of early tirofiban infusion following intravenous thrombolysis in patients with acute ischemic noncardioembolic stroke required assessment.
Does early tirofiban infusion following intravenous thrombolysis improve 90-day functional outcomes and affect intracranial hemorrhage risk across different admission stroke severities in patients with acute ischemic noncardioembolic stroke?
RCT (n=832)
Does early tirofiban infusion following intravenous thrombolysis improve 90-day functional outcomes and affect intracranial hemorrhage risk across different admission stroke severities in patients with acute ischemic noncardioembolic stroke?
Early tirofiban infusion after intravenous thrombolysis significantly improves 90-day functional outcomes without increasing bleeding risk in patients with moderate-to-severe acute ischemic stroke, but offers no benefit and increases intracranial hemorrhage risk in patients with minor stroke.
Answers are grounded in this paper and cite their sources.
Tirofiban may benefit moderate-to-severe stroke but risks bleeding in minor stroke; hypothesis-generating, should not yet change practice.
Background This study aims to assess the effects of stroke severity at admission on the efficacy and safety of early tirofiban infusion following intravenous thrombolysis in patients with acute ischemic noncardioembolic stroke using data from the ASSET‐IT (Advancing Stroke Safety and Efficacy Through Early Tirofiban Administration After Intravenous Thrombolysis) trial. Methods All 832 patients with acute ischemic noncardioembolic stroke from the ASSET‐IT database were included in this exploratory post hoc analysis. The primary efficacy and safety outcomes were an excellent functional outcome (modified Rankin Scale score of 0–1 at 90 days) and intracranial hemorrhage. Results Among the 832 patients included, the median age was 69 (interquartile range, 59–76) years, 531 (63.8%) were men, 367 (44.1%) had minor stroke (National Institutes of Health Stroke Scale score <6), and 465 (55.9%) had moderate‐to‐severe stroke (National Institutes of Health Stroke Scale score ≥6). There were significant interactions between the primary efficacy and safety outcomes ( P interaction =0.008, P interaction =0.03; respectively). We observed that among patients with NIHSS score ≥6, tirofiban markedly increased odds of achieving an excellent functional outcome (adjusted odds ratio, 2.13 [95% CI, 1.44–3.17]; P <0.001) without significantly increasing the risk of intracranial hemorrhage (adjusted odds ratio, 0.88 [95% CI, 0.37–2.09]; P =0.77). In contrast, no significant benefit was observed in the National Institutes of Health Stroke Scale score <6 group (adjusted odds ratio, 1.02 [95% CI, 0.64–1.63]; P =0.94) but there was a significant increase in the risk of intracranial hemorrhage (adjusted odds ratio, 6.51 [95% CI, 1.42–62.03]; P =0.01). Conclusions Early tirofiban infusion may be more beneficial for patients with moderate‐to‐severe stroke treated with intravenous thrombolysis within 4.5 hours of onset, while simultaneously suggesting an increased potential risk of intracranial hemorrhage in minor stroke. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06134622.
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Zhou et al. (2026) conducted an RCT in Acute ischemic noncardioembolic stroke (n=832). Early tirofiban infusion after intravenous thrombolysis vs. Intravenous thrombolysis without tirofiban was evaluated on Excellent functional outcome (modified Rankin Scale score of 0-1 at 90 days) in patients with NIHSS score >=6 (OR 2.13, 95% CI 1.44-3.17, p=<0.001). Early tirofiban after thrombolysis increased 90-day excellent outcome in moderate-to-severe stroke but raised hemorrhage risk in minor stroke.
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