Ischaemic stroke

Glycoprotein IIb/IIIa inhibitors

Tirofiban, a glycoprotein IIb/IIIa inhibitor, inhibits platelet function through its ability to inhibit adenosine diphosphate‐induced platelet aggregation and prolong bleeding time.[196]Krothapalli N, Ortel T, McBride D, et al. Management of incomplete microcirculatory reperfusion after endovascular thrombectomy: focus on inhibition of the glycoprotein IIb/IIIa receptor pathway. Stroke Vasc Interv Neurol. 2024 Mar;4(2):e001048. https://www.ahajournals.org/doi/10.1161/SVIN.123.001048 ​ In an open-label randomised controlled trial (RCT), tirofiban was associated with a greater likelihood of an excellent outcome, defined as a score of 0 or 1 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days, compared with low-dose oral aspirin in patients with ischaemic stroke without occlusion of large or medium-sized vessels who were not eligible for reperfusion therapy or whose symptoms progressed after thrombolysis. Incidence of intracranial haemorrhage was low but slightly higher with tirofiban compared to aspirin (1% vs. 0%).[197]Zi W, Song J, Kong W, et al. Tirofiban for stroke without large or medium-sized vessel occlusion. N Engl J Med. 2023 Jun 1;388(22):2025-36. https://www.nejm.org/doi/10.1056/NEJMoa2214299 http://www.ncbi.nlm.nih.gov/pubmed/37256974?tool=bestpractice.com ​ Although another open-label, RCT in patients ineligible for thrombolysis or thrombectomy found intravenous tirofiban decreased the risk of early neurological deterioration within 72 hours compared with oral aspirin, there was no difference in 90-day functional outcomes.[198]Zhao W, Li S, Li C, et al. Effects of tirofiban on neurological deterioration in patients with acute ischemic stroke: a randomized clinical trial. JAMA Neurol. 2024 Jun 1;81(6):594-602. https://pmc.ncbi.nlm.nih.gov/articles/PMC11036313 http://www.ncbi.nlm.nih.gov/pubmed/38648030?tool=bestpractice.com ​ Tirofiban has yet to be formally recommended in the UK guidelines.