Safety and efficacy of tirofiban combined with endovascular treatment in acute ischaemic stroke

Background and purpose Tirofiban is used off‐label in clinical practice for acute ischaemic stroke ( AIS ). However, it is unknown whether tirofiban increases the bleeding risk or improves the outcome of endovascular treatment ( EVT ) in AIS . This study evaluated the efficacy and safety of tirofiban in combination with EVT for AIS . Methods Consecutive patients with AIS receiving EVT were included in the prospective stroke registry from 2015 to 2018. The efficacy outcomes were modified Rankin Scale ( mRS ) score at 3 months and National Institutes of Health Stroke Scale ( NIHSS ) score at 24 h. The safety outcomes were symptomatic intracerebral hemorrhage ( sICH ), any in‐hospital intracerebral hemorrhage, in‐hospital death and 3‐month death. Results Of 211 patients, 82 (38.9%) received tirofiban. A total of 39 (48.1%) with tirofiban and 44 (36.1%) without tirofiban had mRS score 0–2 [adjusted odds ratio ( OR ), 2.41; 95% confidence interval ( CI ), 1.11–5.23, P = 0.026]. NIHSS score at 24 h was lower in the tirofiban group (9.5 vs. 12.0, adjusted P = 0.032). Five (6.1%) patients with tirofiban and 16 (12.4%) without tirofiban had sICH (adjusted OR , 0.54; 95% CI , 0.16–1.83, P = 0.32). In‐hospital intracerebral hemorrhage occurred in 10 (12.2%) patients with tirofiban and 41 (31.8%) without tirofiban (adjusted OR , 0.32; 95% CI , 0.13–0.76, P = 0.01). In‐hospital death occurred in 7 (8.5%) patients with tirofiban and 16 (12.4%) without tirofiban (adjusted OR , 0.69; 95% CI , 0.22–2.13, P = 0.52). A total of 13 (15.9%) patients with tirofiban and 22 (17.1%) without tirofiban were dead at 3 months (adjusted OR , 0.98; 95% CI , 0.40–2.40, P = 0.96). Conclusions Tirofiban in combination with EVT was associated with a lower mRS score at 3 months and NIHSS score at 24 h. It was not associated with a higher rate of sICH , in‐hospital death and death at 3 months.