Tirofiban improves outcomes in patients with small vessel occlusion strokes who are not eligible for thrombolysis

Clinical Question

For stroke patients who are ineligible for or fail thrombolysis, can tirofiban improve outcomes?

Bottom line

In a population of patients with acute ischemic stroke and no large or medium-sized vessel occlusion who were either not eligible for or failed thrombolysis, tirofiban improves the likelihood of achieving an excellent neurological outcome at 90 days when compared with aspirin. Although tirofiban presented a higher risk of symptomatic intracranial hemorrhage, the incidence of these bleeds was low. Of note, this study was performed on a primarily Chinese population, so results may not be generalizable to other groups. 1b

Study design: Randomized controlled trial (double-blinded)

Funding: Government

Setting: Inpatient (any location) with outpatient follow-up

Reviewer

Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL


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Comments

Anonymous

Lack of sex disaggregated information

The information is not sex-disaggregated, and is therefore useless information. We know that men and women have different risk factors for stroke, different responses to ASA, as well as different risk reduction with the uses of ASA, so this research actually tells us nothing useful.

Arup Kumar Dhara

Impact assessment

Excellent

Anonymous

tirofiban

good information

Dhananjay Desai

Further commentary useful

It would have been nice to see what kind of outcome the "less than excellent" patients had and if the if the 1% risk of symptomatic ICH is worth taking. A cost comparison would also have been useful.