Intravenous Tirofiban Versus Alteplase Before Endovascular Treatment in Acute Ischemic Stroke: A Pooled Analysis of the DEVT and RESCUE BT Trials
Authors: Sang Hongfei , Cao Zhihua , Du Jie , Nguyen Thanh N. , Saver Jeffrey L. , Mao An , Nogueira Raul G. , Tao Zhaojun , Zhou Simin , Han Qin , Sun Dong , Lei Bo , Liu Shudong , Zeng Guoyong , Yin Congguo , Xie Dongjing , Luo Weidong , Jin Zhenglong , Qiu Zhongming , Yang Qingwu , Wu Deping , Shi Zhonghua , Huang Wenguo , Liu Wenhua , Qiu Tao , Zhou Peiyang , Wang Li , Fu Xinmin , Yang Shiquan , Zhang Shuai , Zhou Zhiming , Wang Yan , Luo Jun , Bai Yongjie , Zhang Min , Wu Youlin , Wan Yue , Wen Changming , Wen Hongbin , Ling Wentong , Chen Zhuo. , Peng Miao , Ai Zhibing , Guo Fuqiang , Guo Jing , Guan Haitao , Wang Zhiyi , Liu Yong , Pu Jie , Wang Zhen , Yang Qingwu , Liu Wenhua , Li Huagang , Huang Wenguo , Zhang Min , Zhou Peiyang , Zhou Zhiming , Song Bo , Wen Changming , Yuan Guangxiong , Luo Jun , Zheng Chong , Wang Shouchun , Wang Tao , Qi Li , Wan Yue , Wu Youlin , Peng Daizhou , Chang Mingze , Shi Zhonghua , Jin Ying , Huang Chuming , Liu Tianzhu , Zhao Wenlong , Wang Jian , Wang Li , Liu Shugai , Luo Shiwei , Pu Jie , Chen Shengli , Sun Yaxuan , Jiang Shunfu , Wei Liping , Fu Xinmin , Bai Yongjie , Yang Shunyu , Hu Wei , Zhang Guling , Pan Chengde , Zhang Shuai , Wang Yan , Cao Wenfeng , Yang Shiquan , Zhang Jun , Guo Fuqiang , Wen Hongbin , Zhang Jinhua , Lu Mengjie , Saver Jeffrey L 
Published: September 2024

BACKGROUND:
The present study aimed to evaluate the efficacy and safety of intravenous tirofiban versus alteplase before endovascular treatment (EVT) in acute ischemic stroke patients with intracranial large vessel occlusion.

METHODS:
This was a post hoc analysis using data from 2 multicenter, randomized trials: the DEVT trial (Direct Endovascular Treatment for Large Vessel Occlusion Stroke) from May 2018 to May 2020 and the RESCUE BT trial (Intravenous Tirofiban Before Endovascular Thrombectomy for Acute Ischemic Stroke) from October 2018 to October 2021. Patients with acute intracranial large vessel occlusion within 4.5 hours from last known well were dichotomized into 2 groups: tirofiban plus EVT versus alteplase bridging with EVT. The primary outcome was functional independence (modified Rankin Scale score of 0–2) at 90 days. Safety outcomes included symptomatic intracranial hemorrhage and 3-month mortality. Multivariable logistic regression (adjusting for baseline systolic blood pressure, occlusion site, onset-to-puncture time, anesthesia, and first choice of EVT) and propensity score overlap weighting (balance in demographic covariates, stroke characteristics, and initial management between groups) were performed.

RESULTS:

One-hundred and eighteen alteplase-treated patients in the DEVT trial and 98 tirofiban-treated patients in the RESCUE BT trial were included (median age, 70 years; 115 [53.2%] men). The rate of functional independence was 60.2% in the tirofiban group compared with 46.6% in the alteplase group (adjusted odds ratio, 1.25 [95% CI, 0.60–2.63]). Compared with alteplase, tirofiban was not associated with increased risk of symptomatic intracranial hemorrhage (6.8% versus 9.2%;
P
=0.51) and mortality (17.8% versus 19.4%;
P
=0.76). The propensity score overlap weighting analyses showed consistent outcomes.

CONCLUSIONS:
Among patients with intracranial large vessel occlusion within 4.5 hours of onset, tirofiban plus EVT was comparable to alteplase bridging with EVT regarding the efficacy and safety outcomes. These findings should be interpreted as preliminary and require confirmation in a randomized trial.

REGISTRATION:

URL:
https://www.chictr.org.cn
; Unique identifiers: ChiCTR-IOR-17013568 and ChiCTR-INR-17014167.