Adjunct tirofiban plus IVT safely improves functional outcomes in AIS

Treatment with the short-acting glycoprotein IIb/IIIa inhibitor tirofiban after intravenous thrombolysis (IVT) results in significant improvements in 90-day functional outcomes among patients with acute ischaemic stroke, with no increase in haemorrhage or mortality, a study has shown.

“The addition of tirofiban [to IVT] offers a robust signal for improved functional recovery, likely by addressing the limitation of early vessel re-occlusion,” said study co-author and presenter Dr Yasmin Negida, Virginia Commonwealth University, Richmond, Virginia, US.

Negida and her team conducted a systematic review and meta-analysis to “determine whether adjunct tirofiban after IVT improves 90-day functional outcome without increasing bleeding or mortality.” They identified randomized controlled trials (RCTs) enrolling adults with AIS treated within 4.5 h using the databases of Medline, Scopus, Web of Science, and the Cochrane Library from inception to August 2025.

Eligible trials compared tirofiban plus IVT with IVT alone. Negida and colleagues used random-effects models to pool risk ratios (RRs) and calculate the mean differences (MDs) with 95 percent confidence intervals (CIs). They also quantified heterogeneity using I2.

Excellent function (modified Rankin Scale [mRS] 0–1) and functional independence (mRS 0–2) served as the primary outcomes. Safety outcomes were also measured by evaluating intracranial haemorrhage (ICH), systemic bleeding, and 90-day mortality among AIS patients.

Three RCTs, including a total of 1,132 participants, met the eligibility criteria and were included in the final analysis. [ISC 2026, abstract A007]

Functional outcomes

In the pooled analysis, adjunct tirofiban after IVT led to a significant increase in excellent functional status at 90 days (RR, 1.19, 95 percent CI, 1.07–1.33; p=0.002) and functional independence (RR, 1.20, 95 percent CI, 1.04–1.38; p=0.01), while reducing poor functional outcome (RR, 0.61, 95 percent CI, 0.46–0.81; p=0.0006), among patients with AIS.

Furthermore, stroke patients who received adjunct tirofiban experienced early neurological improvement at 24 to 72 h (MD, –0.70, 95 percent CI, –1.12 to –0.27; p=0.001). On the other hand, no significant difference was noted in National Institutes of Health Stroke Scale score at 5–7 days (MD, –1.37, 95 percent CI, –3.69 to 0.95; p=0.25).

In terms of safety, outcomes measured did not significantly differ between adjunct tirofiban plus IVT and IVT alone groups: any ICH (RR, 1.38, 95 percent CI, 0.79–2.40; p=0.26), symptomatic ICH (RR, 2.28, 95 percent CI, 0.05–110.42; p=0.68), systemic bleeding (RR, 1.16, 95 percent CI, 0.45–2.98; p=0.75), and 90-day mortality (RR, 1.07, 95 percent CI, 0.55–2.09; p=0.84).

The “improvement across mRS 0–1 and 0–2 suggests a consistent, clinically meaningful shift in patient outcomes,” said Negida, noting that this was potentially driven by preventing “early re-occlusion via short-acting GP IIb/IIIA inhibition stabilizing the clot site.”

With these findings, Negida recommended the consideration of an adjunct strategy in controlled settings and the identification of patients at increased risk for re-occlusion.

The study was limited by its (1) small sample size, limiting the statistical power for rare events, (2) heterogeneity, and wide confidence intervals for low-frequency safety endpoints (eg, symptomatic ICH), according to Negida.

“Larger multicentre RCTs are warranted to refine timing, dosing, and selection of candidates” and to confirm these findings, she added.