Early Tirofiban Infusion After Thrombolysis Improves Outcomes in Acute Ischemic Stroke

Acute ischemic stroke remains a major cause of disability worldwide, and despite timely intravenous thrombolysis (IVT), only about half of patients achieve excellent recovery. Vascular reocclusion is a frequent challenge in the early hours following thrombolysis. The ASSET-IT trial, conducted at 38 centers in China, tested whether early tirofiban, a glycoprotein IIb/IIIa inhibitor, could enhance outcomes by reducing platelet-mediated reocclusion.

A total of 832 patients with noncardioembolic ischemic stroke, treated with alteplase (76%) or tenecteplase (24%) within 4.5 hours of symptom onset, were randomized to receive a 24-hour infusion of tirofiban or placebo within 60 minutes of IVT.

Findings:

• At 90 days, excellent functional outcome (mRS 0–1) was achieved in 65.9% of patients in the tirofiban group versus 54.9% in the placebo group (RR 1.20; 95% CI 1.07–1.34; p=0.001).
• Functional independence (mRS 0–2) was also higher with tirofiban (80.4% vs 72.7%).
• The rate of symptomatic intracranial hemorrhage was higher with tirofiban (1.7% vs 0%), though overall mortality was similar (4.1% vs 3.8%).

Interpretation:

Early tirofiban infusion after IVT improved functional recovery in patients with noncardioembolic stroke not eligible for thrombectomy, but at the cost of a modest increase in bleeding risk. The findings support the potential role of targeted antiplatelet therapy in the hyperacute post-thrombolysis period, although applicability may vary across stroke subtypes and populations.

#Stroke #Thrombolysis #Tirofiban #ClinicalTrials #NEJM

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