BackgroundThe clinical efficacy and safety of tirofiban in the treatment of large hemispheric infarction (LHI) remain controversial.MethodsThis study prospectively enrolled patients with acute LHI who were admitted to Putuo Hospital affiliated with Shanghai University of Traditional Chinese Medicine from June 2021 to December 2021. The patients were randomly assigned to the tirofiban group [3–4 μg/(kg·h)] or control group (clopidogrel 75 mg/d).ResultsA total of 71 patients with acute LHI were selected: 36 in the tirofiban group and 35 in the control group. The reduction of the NIHSS score in the tirofiban group was 2.92 ± 9.31 at discharge, and that of the control group was −3.23 ± 12.06 (p = 0.021, OR, 0.006; 95% CI, 0.004–0.008). Six patients (16.7%) in tirofiban group and 14 patients (40%) in control group died during hospitalization (p = 0.029, OR, 0.300; 95% CI, 0.099–0.908). There was significant difference in Modified Rankin Scale (mRS) 5–6 scores at 90 days between the two groups (p = 0.023, OR, 0.327; 95% CI, 0.124–0.867). However, there was no significant difference in mRS 0–1 (p = 0.321, OR, 0.972; 95% CI, 0.920–1.027), mRS 2 (p = 0.572, OR, 2.00; 95% CI, 0.173–23.109), mRS 3 (p = 0.225, OR, 2.214; 95% CI, 0.601–8.161), or mRS 4(p = 0.284, OR, 1.859; 95% CI, 0.593–5.825) scores between the two groups. There was no difference in symptomatic intracranial hemorrhage (p = 0.29, OR, 0.305; 95% CI, 0.030–3.081), asymptomatic intracranial hemorrhage (p = 0.123, OR, 0.284; 95% CI, 0.053–1.518). There was a significant difference in systemic bleeding events during hospitalization (p = 0.044, OR, 0.309; 95% CI, 0.096–1.000).ConclusionsLow-dose and long-course tirofiban treatment may significantly improve the early neurological function and reduce the in-hospital mortality in LHI patients. Meanwhile, tirofiban does not increase the risk of any type of bleeding events.

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Purpose Early neurological deterioration (END) is common after acute ischemic stroke (AIS) and associated with poor outcome. The antithrombotic strategy for END is still a pending question without specific evidence-based recommendation. Whether traditional oral antiplatelet (AP) drug or intravenous tirofiban is more beneficial for END needs further research. Our study aimed to compare the efficacy and safety of tirofiban with oral AP drugs in patients who experienced END without thrombolysis or mechanical thrombectomy and evaluate which stratified population gained the most benefit from tirofiban. Methods A total of 222 AIS patients with END from January 2016 to June 2021 were retrospectively enrolled and divided into the oral AP group and tirofiban group. The functional outcome was assessed with the National Institute of Health Stroke Scale (NIHSS) at discharge and modified Rankin scale (mRS) at 90 days. Results Compared with the oral AP group, more patients in the tirofiban group achieved NIHSS improvement by ≥2 points at discharge (61.7% vs. 25.2%, p = 0.000) and a favorable outcome (mRS 0-2) at 90 days (60.7% vs. 42.6%, p = 0.007). No moderate or severe hemorrhage occurred, and mild hemorrhage was comparable in both groups (p = 0.199). Logistic regression demonstrated that tirofiban was associated with NIHSS improvement at discharge [adjusted odds ratio (OR) 4.930; 95% confidence interval (CI) 2.731-8.898] and 90-day favorable outcome (adjusted OR 2.242; 95% CI 1.080-4.653). Subgroup analysis showed that compared with oral AP, tirofiban improved NIHSS scores at discharge in all subgroups, and improved 90-day mRS in the subgroups of large-artery atherosclerosis (p = 0.004), age ≤75 years (p = 0.03), and NIHSS 4-7 (p = 0.001). Conclusions Based on our results, tirofiban monotherapy could be an alternative to traditional oral AP strategy for the treatment of END.