Administration route factors in efficacy of adjunctive tirofiban for stroke

Tirofiban as an adjunct to endovascular thrombectomy in acute ischaemic stroke patients may be beneficial or detrimental depending on the route of administration, such that intravenous treatment leads to high recanalization rate and good outcome, whereas the intra-arterial route is associated with increased bleeding and mortality, according to a study.

The retrospective study included 503 stroke patients with large vessel occlusion who underwent endovascular thrombectomy within 24 hours of symptom onset. Tirofiban was administered via intravenous infusion in 70 patients or intra-arterial injection in 79 patients; the majority (n=354) did not receive treatment.

Researchers applied propensity score matching to compare outcomes including recanalization rate, symptomatic intracerebral haemorrhage (sICH), in-hospital death rate, 3-month death, and 3-month functional outcome measured by modified Rankin Scale score (good outcome, 0–2; poor outcome, 5–6). Matching yielded 92 matched patients each in the no-treatment, intravenous, and intra-arterial tirofiban groups (some patients were matched more than once in every group).

Compared with the no-tirofiban group, the intravenous group had significantly higher rates of recanalization (96.7 percent vs 64.1 percent; p<0.001) and 3-month good functional outcome (69.5 percent vs 51.2 percent; p=0.034), as well as a lower 3-month poor outcome rate (12.2 percent vs 41.4 percent; p<0.001). There was no between-group difference seen in sICH (2.2 percent vs 0 percent; p=1.000).

However, between the no-tirofiban and intra-arterial groups, the latter was associated with markedly increased sICH (19.1 percent vs 0 percent; p<0.001), with higher rates of in-hospital death (23.6 percent vs 0 percent; p<0.001) and 3-month death (26.8 percent vs 11.1 percent; p=0.021). There was no difference in recanalization rate (66.3 percent vs 64.1 percent; p=1.000).

The findings highlight the potential of intravenous tirofiban as a periprocedural adjunctive treatment for patients undergoing endovascular thrombectomy, especially those with atherosclerosis stenosis, the researchers said.