Association of tirofiban with discharge functional outcomes in acute ischemic stroke: a retrospective cohort study

Tirofiban, a glycoprotein IIb/IIIa receptor antagonist, has been investigated for acute ischemic stroke (AIS), but its association with early discharge functional outcomes remains uncertain. This study evaluated the association between tirofiban use and discharge outcomes in AIS patients.

We enrolled 344 consecutive AIS patients, including 191 who received tirofiban and 153 who did not. Missing data were handled using multiple imputation. Analyses included propensity score matching, multivariable linear regression with HC3 robust standard errors, ordinal logistic regression, subgroup analyses, sensitivity analyses, restricted cubic spline analysis, and E-value analysis. Primary outcomes were discharge modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores.

After adjusting for nine relevant covariates, tirofiban use was associated with significantly lower discharge mRS scores (β = -0.352, 95% CI -0.625 to -0.079, p = 0.011). This remained robust under HC3 robust standard errors (p = 0.020), ordinal logistic regression (OR = 0.434, 95% CI 0.267-0.706, p < 0.001), and propensity score matching (mean difference = -0.456, 95% CI -0.879 to -0.033, p = 0.035). The association was consistent across age, sex, and admission NIHSS subgroups, with an E-value of 2.40. No significant association was observed between tirofiban use and discharge NIHSS scores.

These findings suggest tirofiban use is associated with better early functional outcomes in AIS patients, as reflected by lower discharge mRS scores. The robustness across multiple analytical approaches strengthens the validity of these observations. Further prospective multicenter randomized controlled trials are warranted.