In treating patients who have recently experienced a stroke or progression of stroke symptoms without occlusion of large or medium-sized cerebral vessels, choosing an optimal treatment strategy can be challenging.
Existing therapies such as thrombolysis or thrombectomy may not always be suitable, leaving a need for additional options to improve patient outcomes.
Wenjie Zi, M.D., and colleagues from Xinqiao Hospital and the Second Affiliated Hospital in Chongqing, China, conducted a multicenter trial involving patients with ischemic stroke who did not have occlusion of large or medium-sized vessels.
These patients also had a National Institutes of Health Stroke Scale score of 5 or greater, and at least one moderately to severely weak limb.
Patients were either ineligible for thrombolysis or thrombectomy, had recently experienced a stroke, saw progression of stroke symptoms soon after onset, had early neurological deterioration after thrombolysis, or saw no improvement from thrombolysis at four to 24 hours.
The study involved 606 patients who received intravenous tirofiban (plus oral placebo) and 571 patients who were given oral aspirin (plus intravenous placebo) for two days. All participants then received oral aspirin until day 90.
The researchers discovered that 29.1% of patients receiving tirofiban and 22.2% of patients receiving aspirin had a score of 0 or 1 on the modified Rankin scale at 90 days, indicating an excellent outcome (adjusted risk ratio, 1.26).
However, the results for the secondary endpoints were not consistent with those for the primary analysis.
Mortality rates were similar between the two groups. Symptomatic intracranial hemorrhage was recorded in 1.0% of the tirofiban group and in none of the aspirin group.
The authors concluded that intravenous tirofiban was associated with a higher likelihood of an excellent outcome at 90 days than oral aspirin.
This study adds to the understanding of how tirofiban, a medication that helps prevent platelets in the blood from sticking together and forming clots, could be a useful treatment for specific stroke patients.
It suggests that for patients with recent onset or progression of stroke symptoms and no occlusion of large or medium-sized cerebral vessels, tirofiban may provide a better outcome compared to aspirin.
If you care about stroke, please read studies about what to eat for stroke prevention, and small surgery can prevent strokes in people with heart issues.
For more information about stroke, please see recent studies about drug combo that can cut risk of stroke and heart attack by half, and results showing MIND diet could slow down cognitive decline after stroke.
The study was published in the New England Journal of Medicine.
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