Post-Thrombolysis Antiplatelet Strategies and Functional Recovery in Mild Ischemic Stroke with Disabling Symptoms: A Retrospective Cohort Study

BACKGROUND: Mild ischemic stroke (MIS) patients with disabling symptoms often receive intravenous thrombolysis; however, the optimal post-thrombolysis antiplatelet regimen, especially for those at risk of early neurological deterioration (END), remains uncertain. OBJECTIVES: To compare the clinical efficacy and safety of three post-thrombolysis antiplatelet strategies in MIS patients with disabling symptoms or END. METHODS: This retrospective cohort study included 243 MIS patients (NIHSS ≤ 3) who received intravenous thrombolysis. Patients were assigned to one of three groups based on antiplatelet regimens initiated 24 hours post-thrombolysis: aspirin monotherapy, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel, or tirofiban bridging followed by sequential DAPT. Clinical outcomes, including NIHSS improvement, modified Rankin Scale (mRS) scores, and adverse events, were evaluated on Day 7 and Day 90. Multivariate logistic regression was used to identify predictors of favorable functional outcomes (mRS ≤ 2 at 90 days). RESULTS: At Day 7, the tirofiban group exhibited significantly lower NIHSS scores (1.5 ± 1.1) compared to the aspirin group (2.1 ± 1.3; P = 0.04). At Day 90, the tirofiban group had the highest rate of functional independence (84.6% vs. 75.0% in the aspirin group). Multivariate analysis identified tirofiban bridging as an independent predictor of favorable outcomes (OR = 2.08, 95% CI: 1.01-4.30; P = 0.047). Safety outcomes, including symptomatic intracranial hemorrhage and systemic bleeding, were comparable across all groups. CONCLUSION: Tirofiban bridging followed by dual antiplatelet therapy may enhance early neurological recovery and long-term functional outcomes without increasing bleeding risk in MIS patients with disabling symptoms or END.