Tirofiban improves functional outcome, prevents haemorrhage in stroke patients

Endovascular treatment (EVT) with intravenous tirofiban prior to thrombectomy appears to improve functional outcome and reduce the risk of any intracranial haemorrhage in patients with large vessel occlusion treated within 4.5 hours after stroke onset compared with alteplase, a study has shown.

The authors conducted a post hoc analysis using data from 467 patients who were enrolled in two multicentre, randomized clinical trials (DEVT and RESCUE BT) assessing intravenous adjunctive medications in stroke thrombectomy. Patients received treatment with EVT alone (n=172), intravenous tirofiban plus EVT (n=172), or intravenous alteplase plus EVT (n=123).

Functional independence (modified Rankin scale score 0‒2) at 90 days was the primary outcome, while intracranial haemorrhage and mortality were the safety outcomes.

Patients in the tirofiban plus EVT group were more likely to achieve functional independence than those in the alteplase plus EVT group (adjusted risk ratio [aRR], 0.80, 95 percent confidence interval [CI], 0.65‒0.99; p=0.04).

Patients in the EVT-alone group were also more likely to attain functional independence than those in the tirofiban plus EVT group (aRR, 1.12, 95 percent CI, 0.92‒1.36; p=0.27) or the alteplase plus EVT group (aRR, 0.81, 95 percent CI, 0.65‒1.02; p=0.07).

Additionally, patients treated with alteplase plus EVT were at higher risk of any intracranial haemorrhage than those treated with EVT alone (aRR, 1.49, 95 percent CI, 1.03‒2.14; p=0.03) and tirofiban plus EVT (aRR, 1.49, 95 percent CI, 1.02‒2.18; p=0.04).

“No significant difference was detected in the incidence of symptomatic intracranial haemorrhage and mortality among the three groups,” the authors said.