Aggrastat Treatment Reduces Early Neurological Deterioration in Patients with Acute Ischemic Stroke

According to study results published in JAMA Neurology, intravenous (IV) Aggrastat (tirofiban hydrochloride; Medicure, Winnipeg, Mannitoba, Canada) administered within 24 hours of symptom onset decreased the risk of early neurologic deterioration in patients with acute noncardioembolic ischemic stroke compared to treatment with oral aspirin. Additionally, the study found no increased risk of symptomatic intracerebral hemorrhage (ICH) with Aggrastat treatment. These results are important because neurologic deterioration is still common in patients receiving antiplatelet therapy for acute ischemic stroke.

The investigator-initiated, multicenter, open-label, randomized trial (NCT04491695) included individuals aged 18 to 80 years with acute noncardioembolic ischemic stroke within 24 hours of onset and National Institutes of Health Stroke Scale (NIHSS) scores of 4 to 20 (N=425). The study was conducted from September 2020 to March 2023 at 10 comprehensive stroke centers in China. Participants were randomly assigned 1:1 to receive either intravenous Aggrastat (n=213) or oral aspirin (n=212) for 72 hours, followed by oral aspirin for all participants. The primary efficacy outcome was early neurologic deterioration, defined as an increase in NIHSS score of 4 points or more within 72 hours, and the primary safety outcome was symptomatic intracerebral hemorrhage within 72 hours after treatment.

• Early neurological deterioration occurred in 9 individuals (4.2%) in the Aggrastat group and 28 individuals (13.2%) in the aspirin group (adjusted relative risk, 0.32; 95% CI, 0.16 to 0.65; P=.002).
• No patients in the Aggrastat group experienced ICH.
• At 90-day follow-up, mortality rates and modified Rankin Scale (mRS) scores were similar between the Aggrastat and aspirin groups.