Tirofiban as an Adjunct to Thrombolysis in Ischemic Stroke
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Reviewed by Dat Tien Nguyen, B.A, ScM.
Translated by Nhi Phuong Quynh Le, B.A |
Posted on October 13th, 2025
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For ischemic stroke, intravenous thrombolysis is recommended within 4.5 hours of onset. However, even with timely treatment, more than half of patients fail to regain full function. To increase treatment efficacy, the Chinese government funded a study to evaluate whether tirofiban could improve recovery outcomes when added to standard thrombolysis.
The trial enrolled 832 patients with a median age of 69 years, all hospitalized for ischemic stroke and treated with intravenous thrombolysis at a median of 2.5 hours after onset. 75% received alteplase and the remainder with tenecteplase. Eligibility required a modified Rankin Scale score of 0 or 1, indicating no to minimal disability, before stroke onset.
Participants were randomized to receive either placebo or tirofiban intravenously. Tirofiban was administered as a 0.4 μg/kg bolus over 30 minutes, followed by a 23.5-hour infusion at 0.1 μg/kg/min. As a glycoprotein IIb/IIIa receptor antagonist, tirofiban prevents platelet aggregation and thrombus formation, thereby reducing the risk of reocclusion.
At 90-day follow-up, 65.9% of patients treated with tirofiban achieved no or minimal disability, compared with 54.9% in the placebo group. The benefit was most pronounced in patients over 70 years of age treated with alteplase. Mortality and rates of intracranial hemorrhage did not differ significantly between groups. The authors noted that reliance on SITS-MOST criteria may have led to misclassification of some patients with clinically significant deterioration as not having symptomatic intracranial hemorrhage.
The trial enrolled 832 patients with a median age of 69 years, all hospitalized for ischemic stroke and treated with intravenous thrombolysis at a median of 2.5 hours after onset. 75% received alteplase and the remainder with tenecteplase. Eligibility required a modified Rankin Scale score of 0 or 1, indicating no to minimal disability, before stroke onset.
Participants were randomized to receive either placebo or tirofiban intravenously. Tirofiban was administered as a 0.4 μg/kg bolus over 30 minutes, followed by a 23.5-hour infusion at 0.1 μg/kg/min. As a glycoprotein IIb/IIIa receptor antagonist, tirofiban prevents platelet aggregation and thrombus formation, thereby reducing the risk of reocclusion.
At 90-day follow-up, 65.9% of patients treated with tirofiban achieved no or minimal disability, compared with 54.9% in the placebo group. The benefit was most pronounced in patients over 70 years of age treated with alteplase. Mortality and rates of intracranial hemorrhage did not differ significantly between groups. The authors noted that reliance on SITS-MOST criteria may have led to misclassification of some patients with clinically significant deterioration as not having symptomatic intracranial hemorrhage.