China: Researchers in a recent study published in the Journal of the American Medical Association (JAMA) advise against the use of intravenous tirofiban before endovascular treatment for acute ischemic stroke.
RESCUE BT trial showed that treatment with intravenous tirofiban before endovascular therapy in patients with large vessel occlusion acute ischemic stroke undergoing endovascular thrombectomy did not result in a significant difference in disability severity at 90 days versus placebo.

Tirofiban is a highly selective nonpeptide antagonist of glycoprotein IIb/IIIa receptor that reversibly inhibits platelet aggregation. However, it is not certain of IV tirofiban is effective in improving functional outcomes for patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy.
Against the above background, Zhongming Qiu, MD (Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University, Chongqing, China, and colleagues aimed to assess the efficacy and adverse events of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke secondary to large vessel occlusion in an investigator-initiated, randomized, double-blind, placebo-controlled trial implemented at 55 hospitals in China.
The trial enrolled 948 patients with stroke and proximal intracranial large vessel occlusion presenting within 24 hours of time last known well. Recruitment was done between October 10, 2018, and October 31, 2021.
463 participants received intravenous tirofiban and 485 received placebo prior to endovascular thrombectomy. The study's main outcome was disability level at 90 days as measured by the overall distribution of the modified Rankin Scale scores from 0 (no symptoms) to 6 (death). The incidence of symptomatic intracranial hemorrhage within 48 hours was the primary safety outcome.
Based on the study, the researchers reported the following findings:
Among 948 patients randomized (mean age, 67 years; 391 [41.2%] women), 948 (100%) completed the trial.
The median (IQR) 90-day modified Rankin Scale score in the tirofiban group vs placebo group was 3 vs 3.
The adjusted common odds ratio for a lower level of disability with tirofiban vs placebo was 1.08.
Incidence of symptomatic intracranial hemorrhage was 9.7% in the tirofiban group vs 6.4% in the placebo group (difference, 3.3%).
The researchers conclude, "findings do not support the use of intravenous tirofiban before endovascular thrombectomy for acute ischemic stroke."
Reference:
RESCUE BT Trial Investigators. Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke: The RESCUE BT Randomized Clinical Trial. JAMA. 2022;328(6):543–553. doi:10.1001/jama.2022.12584