Intravenous tirofiban in non-LVO progressive stroke beyond the thrombolysis window

Neurological worsening after hospital admission frequently correlates with poor clinical prognosis. However, treatment options are limited for acute ischemic stroke patients who are outside the thrombolytic time window and do not have large vessel occlusion (LVO).

This study evaluated the safety and efficacy of intravenous tirofiban in this population.

A total of 44 patients diagnosed with progressive ischemic stroke were analyzed, defined as an increase of ≥2 points on the NIHSS or a ≥1-point worsening in limb motor score within 24 hours of symptom onset. of these, 26 received intravenous tirofiban in addition to dual antiplatelet therapy, while the remaining 18 received dual antiplatelet therapy alone. The primary efficacy endpoints were the NIHSS score at 7 days and the proportion of patients achieving a superior functional outcome [modified Rankin Scale (mRS) score 0-1] at 3 months. Symptomatic intracranial hemorrhage, systemic bleeding events and thrombocytopenia were monitored.

The tirofiban group showed greater neurological improvement at 7 days (p < 0.001) and an increased favorable outcome at 90 days (80.77% vs 27.78%, p = 0.001). Logistic regression confirmed tirofiban as an independent parameter of favorable outcome (adjusted OR 15.67, 95% CI: 2.97-82.61, p = 0.001). Neither group presented symptomatic intracranial hemorrhage, systemic bleeding, or thrombocytopenia.

Intravenous tirofiban may represent a potential therapeutic option for patients with progressive ischemic stroke beyond the thrombolytic window and without LVO, showing an association with improved neurological recovery and functional outcomes. Its clinical efficacy and safety shall be further confirmed through large-scale, randomized, prospective studies.