Adding Tirofiban on Top of Recombinant Tissue Plasminogen Activator May Improve Clinical Outcome in Acute Stroke Patients
Ruhui Liu, Zhigang Liang, Wei Li, Yan Zhan, Luyao Xu, Shaowan Yang, Guomin Zheng, Jiang Li, Liwen Xie, Zhongwen Sun, Yinbao Hu
Abstract
Stroke remains the leading cause of disability-adjusted life-years and deaths in China. 1 Current guidelines recommend intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) for treating acute ischemic stroke (AIS) patients. 2However, platelet activation can trigger vascular re-occlusion after IVT.Tirofiban, an antagonist for platelet glycoprotein IIb/IIIa, can prevent microvascular thrombosis and improve cerebral blood flow, 3 as studies have confirmed its safety and clinical efficacy in combination with rt-PA for AIS. 4,5ecent advancements have positioned image-guided IVT as the cornerstone of precise vascular recanalization therapy.To assess the efficacy and safety of this approach, we conducted a single-center, randomized, open-label, controlled clinical trial.The study protocol was approved by the medical ethics committee of Yantai Yuhuangding Hospital affiliated to Qingdao University (ID 2019-309).All patients provided written informed consent before enrollment.We aimed to compare the outcomes of patients receiving saline after IVT with rt-PA (rt-PA group) to those receiving intravenous tirofiban within 2-6 hours after IVT with rt-PA (rt-PA+T group).In the rt-PA+T group, tirofiban was given at the first dose of 0.4 g/kg/min within 30 minutes, followed by continuous delivery at a rate of 0.1 g/kg/min for 72 hours using a micropump.Patient selection considerations included: stroke etiology was based on the Trial of ORG 10172 in Acute Stroke Treatment (TOAST),