Early antiplatelet therapy was associated with reduced neurological deterioration in stroke patients treated with intravenous thrombolysis

Abstract BACKGROUND: Patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) are at high risk of early neurological deterioration (END) due to increased platelet activation. OBJECTIVES: The objective of the study was to investigate the safety and efficacy of early antiplatelet therapy in reducing END postthrombolysis, and identify patients who may benefit. METHODS: In this observational study, AIS patients receiving IVT were stratified into the early tirofiban group and the control group according to antiplatelet therapy during the first 24 h following IVT. The primary endpoint was END 4 (the National Institutes of Health Stroke Scale score increase ≥ 4 points) within 72 h following IVT. Binary logistic regression with propensity-score-matching was applied to analyze outcomes between the groups. RESULTS: Of the 319 patients enrolled, 66 in the early tirofiban group and 120 matched controls were analyzed. END 4 occurred in four patients (6.1%) with early tirofiban and 15 patients (12.5%) in the control group. Early tirofiban administration was associated with lower odds of END 4 (adjusted odd ratio, 0.2; 95% confidence interval, 0.1–0.8). Intracranial hemorrhage occurred in 2 (3.0%, none symptomatic) and 3 (2.5%, 2 symptomatic) patients, respectively, with no significant association between early tirofiban and major bleeding or mortality. Early tirofiban was significantly correlated with reduced END 4 among patients aged 66–80 years, those without prestroke antiplatelet therapy, and those with neutral response to IVT (adjusted P < 0.05). CONCLUSION: Early tirofiban therapy following IVT was associated with reduced END without increased bleeding risk. Specific patient subgroups may potentially benefit from early antiplatelet therapy, further confirmation is needed.