Poststroke Neurologic Deterioration Reduced With Tirofiban, Study Finds

Wenbo Zhao, MD

Data from the TREND randomized controlled trial (NCT04491695) showed that treatment with tirofiban, an antiplatelet medication, resulted in reduced early neurological deterioration (ND) that was greater than oral antiplatelet therapy alone in patients with acute ischemic stroke (AIS). Study investigators concluded that larger studies are warranted to determine its benefit on functional outcomes in this patient population.¹

Led by Wenbo Zhao, MD, a medical doctor at Xuanwu Hospital in Beijing, China, the study featured 426 patients with AIS who did not receive intravenous thrombolysis or endovascular treatment within 24 h of ictus. These individuals were randomly assigned to intravenous (IV) tirofiban for 72 h, followed by oral antiplatelet therapy (n = 214) or oral antiplatelet treatment directly (n = 212). Results showed that the primary outcome of ND, defined as an increase of more than 4 points on the National Institute of Health Stroke Scale (NIHSS) score, occurred in 9 patients (4.2%) in the tirofiban and 28 (13.2%) in the control group (rate ratio [RR], 0.32; 95% CI, 0.15-0.66; P = .001).

Presented at the 2024 International Stroke Conference (ISC), held February 7-9, in Phoenix, Arizona, the trial also assessed outcomes of systemic bleeding and the proportion of non-disability at 90 days, defined as an mRS score of 0 to 1. All told, 75.2% (n = 161) of tirofiban-treated patients achieved non-disability at the follow-up time point vs 68.4% (n = 145) of those in the control group (RR, 1.10; 95% CI, 0.98-1.24; P = .117). Between the 2 groups, investigators observed no difference in the incidence of systemic bleeding.

READ MORE: Fibrinogenase Injection Improves Functional Outcome Following Ischemic Stroke

Tirofiban is a fast-acting, highly selective, low-molecular-weight nonpeptide glycoprotein IIb/IIIa receptor inhibitor with a short half-life that allows bleeding time to revert to normal within approximately 3 hours after its administration is stopped. The safety and efficacy of tirofiban in the early management of stroke were assessed in the Study of Efficacy of Tirofiban in Acute Ischemic Stroke, which was stopped early for lack of efficacy,² and the Safety of Tirofiban in Acute Ischemic Stroke trial, which showed no beneficial effect on stroke outcomes at 1 week or 5 months.³

In 2023, investigators published results in the New England Journal of Medicine on the RESCUE BT2 trial assessing tirofiban in patients with AIS without large or medium-sized vessel occlusion. In the study, patients were assigned to IV tirofiban (plus oral placebo; n = 606) or oral aspirin (100 mg per day, plus IV placebo; n = 571) for 2 days; all patients then received oral aspirin until day 90. Results showed that 29.1% of tirofiban-treated patients had an mRS score of 0 or 1 at 90 days vs 22.2% of those on aspirin (adjusted risk ratio, 1.26; 95% CI, 1.04-1.53; P = .02). Mortality was similar between the 2 groups; however, there was an incidence of symptomatic intracranial hemorrhage (1.0%) in the tirofiban group vs no cases (0%) in the aspirin group.⁴

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REFERENCES
1. Wenbo Z, Sijie L, Wang J, et al. Intravenous tirofiban reduces early neurological deterioration in acute ischemic stroke: the TREND randomized controlled clinical trial. Presented at: International Stroke Conference; February 7-9, 2024; Abstract LB12
2. Torgano G, Zecca B, Monzani V, et al. Effect of intravenous tirofiban and aspirin in reducing short-term and long-term neurologic deficit in patients with ischemic stroke: a double-blind randomized trial. Cerebrovasc Dis 2010;29:275-281.
3. Siebler M, Hennerici MG, Schneider D, et al. Safety of Tirofiban in acute Ischemic Stroke: the SaTIS trial. Stroke 2011;42:2388-2392.
4. Zi W, Song J, Kong W, et al. Tirofiban for stroke without large or medium-sized vessel occlusion. NEJM. 2023;388;2025-2036. doi:10.1056/NEJMoa2214299