Safety and Efficacy of Ultra‐Early Tirofiban Treatment Following Alteplase in Patients With Noncardioembolic Acute Ischemic Stroke

Background Secondary platelet activation peaks ≈2 hours after intravenous thrombolysis with alteplase. This study evaluated the safety and efficacy of ultra‐early tirofiban administration and compared different tirofiban regimens following intravenous thrombolysis in patients with noncardioembolic acute ischemic stroke. Methods This observational study enrolled patients with acute ischemic stroke who received tirofiban within 24 hours following intravenous thrombolysis. Patients were divided into ultra‐early (within 2 hours) and early (2–24 hours) groups based on tirofiban initiation time. A secondary analysis was performed based on whether the tirofiban regimen included a bolus dose. The primary outcome was 90‐day excellent functional outcome (modified Rankin Scale score 0–1). The safety outcomes included symptomatic intracranial hemorrhage, intracranial hemorrhage, and 3‐month all‐cause mortality. Results A total of 472 patients were enrolled, with 214 in the ultra‐early tirofiban group and 258 in the early tirofiban group. The ultra‐early tirofiban group was associated with 3‐month excellent functional outcomes (67.5% versus 53.3%; adjusted odds ratio [aOR], 1.56 [95% CI, 1.01–2.42]). There were no significant differences in intracranial hemorrhage (3.7% versus 1.6%; P =0.18), symptomatic intracranial hemorrhage (0.5% versus 0.4%; P =0.99), or 3‐month mortality (1.5% versus 2.5%; P =0.94). Propensity score matching analyses showed consistent outcomes. No significant differences in excellent functional outcomes (61.4% versus 71.0%; aOR, 0.68 [95% CI, 0.36–1.30]) or symptomatic intracranial hemorrhage (0.4% versus 0%; P =0.99) were observed between bolus and maintained groups for prophylactic tirofiban after intravenous thrombolysis. Conclusions Ultra‐early tirofiban administration following recombinant tissue plasminogen activator was associated with excellent functional outcomes without increasing the risk of symptomatic intracranial hemorrhage, intracranial hemorrhage, or mortality. The extra bolus dose did not show superiority over only maintained dose administration.