ABSTRACT NUMBER: ESOC2026A775 DIABETES HISTORY AND EFFICACY OF EARLY TIROFIBAN INFUSION AFTER IVT IN ISCHEMIC STROKE: A POST-HOC ANALYSIS OF THE ASSET-IT TRIAL

Abstract Background and aims To investigate how diabetes mellitus influences the efficacy of early tirofiban administration after intravenous thrombolysis in patients with acute ischemic noncardioembolic stroke. Methods This was a post hoc analysis of the ASSET-IT trial. Patients were categorized into DM and non-DM groups based on baseline diabetes history. The primary efficacy outcome was excellent functional outcome at 90 days, defined as an mRS score of 0–1. Safety outcomes included symptomatic intracranial hemorrhage (sICH) within 36 hours, any intracranial hemorrhage, and all-cause mortality within 90 days. The effect of diabetes on treatment outcomes was assessed using multivariable regression models adjusting for relevant confounders. Results A total of 832 patients at 38 centers were randomized in the ASSET-IT trial (414 to tirofiban, 418 to placebo). The median age was 69 years (interquartile range, 59 -76); 301 (36.2%) were women. Overall, 191 patients (23.0%) had diabetes mellitus. Among non-DM patients, excellent functional outcome (mRS 0-1) at 90 days was achieved in 69% with tirofiban versus 55.8% with placebo (RR, 1.22; 95% CI, 1.09-1.37; P=0.001); among DM patients, the rates were 55% versus 52% (RR, 1.03; 95% CI, 0.79-1.34; P=0.846). The 90-day mortality was higher in the DM group receiving tirofiban (6.6% vs 2.0%; RR, 3.79; 95% CI, 0.84-17.05; P=0.082) but not in the non-DM group (3.4% vs 4.4%; RR, 0.82; 95% CI, 0.40-1.70; P=0.597). Conclusions Diabetes mellitus was associated with attenuated therapeutic benefit of early tirofiban administration after intravenous thrombolysis in acute ischemic stroke. Prospective studies are warranted to confirm these observations. Conflict of interest all authors,nothing to disclose