Intravenous Tirofiban Reduces Neurological Deterioration in Acute Noncardioembolic Stroke: JAMA

Acute ischemic stroke remains a significant health challenge globally, and antiplatelet therapy is a cornerstone of its management. However, patients continue to experience neurological deterioration despite recommended treatment, which can lead to poor clinical outcomes. Investigators aimed to evaluate whether intravenous tirofiban could prevent early neurological deterioration in patients with acute noncardioembolic stroke compared to oral aspirin.

This multicenter, open-label, randomized clinical trial enrolled 425 patients aged 18 to 80 years with acute noncardioembolic stroke within 24 hours of onset. Patients were assigned randomly to receive either intravenous tirofiban (n = 213) or oral aspirin (n = 212) for 72 hours. All patients received oral aspirin afterward. The primary efficacy outcome was early neurological deterioration (increase in National Institutes of Health Stroke Scale [NIHSS] score ≥4 points) within 72 hours after randomization. The primary safety outcome was symptomatic intracerebral hemorrhage within the same timeframe.

The key findings of the study were:

• Early neurological deterioration occurred in 4.2% of patients in the tirofiban group compared to 13.2% in the aspirin group (adjusted relative risk [RR], 0.32; 95% CI, 0.16-0.65; P = .002).

• No patients in the tirofiban group experienced symptomatic intracerebral hemorrhage.

• At 90-day follow-up, mortality rates were similar in both groups (1.3% in the tirofiban group and 1.5% in the aspirin group).

• Median modified Rankin scale scores at 90 days were comparable between the groups (1.0 for both groups).

The study demonstrates that intravenous tirofiban may provide a significant benefit in reducing early neurological deterioration in patients with acute noncardioembolic stroke. The lack of increased risk for symptomatic intracerebral hemorrhage suggests that tirofiban is a safe option for early stroke intervention.

In patients with noncardioembolic stroke seen within 24 hours of symptom onset, intravenous tirofiban decreases the risk of early neurological deterioration without increasing the risk of symptomatic intracerebral hemorrhage or systematic bleeding. This treatment may offer an alternative to the current antiplatelet regimen for acute ischemic stroke management.

Reference:

Zhao, W., Li, S., Li, C., Wu, C., Wang, J., Xing, L., Wan, Y., Qin, J., Xu, Y., Wang, R., Wen, C., Wang, A., Liu, L., Wang, J., Song, H., Feng, W., Ma, Q., Ji, X., Ding, J., … TREND Investigators. (2024). Effects of tirofiban on neurological deterioration in patients with acute ischemic stroke: A randomized clinical trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2024.0868