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Intravenous tirofiban before endovascular treatment increases risk of parenchymal hematoma type 2Trial shows tirofiban increases bleeding risk in some stroke patients

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Key Takeaway
Note that intravenous tirofiban before endovascular treatment increases the risk of parenchymal hematoma type 2.

This randomized controlled trial enrolled 945 patients with acute large vessel occlusion of the anterior circulation to evaluate the impact of intravenous tirofiban administered before endovascular treatment. The study compared tirofiban against a placebo.

The primary outcome was radiologic intracranial hemorrhage (ICH) subtypes. Patients receiving tirofiban showed an increased risk of any radiologic intracranial hemorrhage compared with placebo (adjusted RR 1.25; 95% CI 1.04-1.51, P=0.018). Among the 945 patients, 296 (31.3%) experienced radiologic ICH.

Secondary outcomes included parenchymal hematoma type 2 (PH-2). The study found an increased risk of PH-2 in the tirofiban group compared with placebo (adjusted RR 1.77; 95% CI 1.04-3.03, P=0.036). An exploratory analysis further indicated a higher risk of PH-2 specifically in patients with cardioembolic stroke receiving tirofiban (P=0.031).

Safety and tolerability data were not reported. The study highlights that intravenous tirofiban preceding endovascular treatment significantly increases PH-2 risk in large vessel occlusive stroke. Clinicians should consider these risks when managing patients with acute anterior circulation occlusions.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in the management of acute large vessel occlusion by identifying a specific risk associated with tirofiban. While other covered items discuss the safety of tenecteplase, magnesium sulfate, dual antiplatelet therapy, early oral anticoagulants, and cardiac rehabilitation, this study specifically highlights the increased risk of parenchymal hematoma type 2 when using tirofiban before endovascular treatment.

Researchers conducted a large study involving 945 patients who experienced a specific type of stroke involving a large blood vessel. The study looked at what happens when patients receive the medication tirofiban before undergoing a procedure to clear the blockage.

The results showed that patients who received tirofiban had a higher risk of experiencing a radiologic intracranial hemorrhage compared to those who received a placebo. Specifically, the study found a higher risk of a certain type of bleeding called parenchymal hematoma type 2. This risk was also noted in patients who had a cardioembolic stroke, though this specific finding was part of an exploratory analysis.

Because this study shows a link between the medication and an increased risk of bleeding, the results are important for doctors to consider when choosing treatments. However, these findings are specific to the conditions and medications studied. You should talk to your doctor to understand how these results might affect your specific treatment plan.

What this means for you:
Tirofiban may increase the risk of specific types of brain bleeding in some patients with large vessel stroke.

Common questions

What did the study find about tirofiban and stroke?

The study of 945 patients found that patients who received intravenous tirofiban before treatment had an increased risk of radiologic intracranial hemorrhage compared to those who received a placebo. Specifically, the risk of a type of bleeding called parenchymal hematoma type 2 was higher in the group receiving tirofiban.

Is there a specific risk for certain types of stroke?

The study included an exploratory analysis for patients with cardioembolic stroke. In these cases, the results showed a higher risk of parenchymal hematoma type 2 when the patients received tirofiban. You should discuss these specific risks with your medical provider.

How many people were involved in this study?

The study included a large group of 945 patients who had acute large vessel occlusion of the anterior circulation. Out of these 945 patients, 296, or about 31.3 percent, experienced a radiologic intracranial hemorrhage.

Study Details

Study typeRct
EvidenceLevel 2
PublishedSep 2026
View Original Abstract ↓
PURPOSES: Intracranial hemorrhage (ICH) is a serious complication after endovascular treatment (EVT) for large vessel occlusive stroke. Using data from RESCUE BT, we aimed to investigate the relationship between intravenous tirofiban preceding EVT and radiologic ICH subtypes in acute large vessel occlusion of anterior circulation undergoing EVT. METHODS: Patients were randomly assigned in a 1:1 ratio to receive intravenous tirofiban or placebo before EVT. Radiologic ICH subtypes according to the Heidelberg bleeding classification, including hemorrhagic infarction type 1 (HI-1), hemorrhagic infarction type 2 (HI-2), parenchymal hematoma type 1 (PH-1), parenchymal hematoma type 2 (PH-2) and Extra-parenchymal hemorrhage, were evaluated through follow-up imaging. A Poisson regression analysis was performed to identify the association between tirofiban and radiologic ICH subtypes. Factors modifying the tirofiban effect on ICH subtypes were exploratorily analyzed. RESULTS: The radiologic ICH developed in 296 (31.3%) of 945 included patients. In patients with ICH, HI-1 occurred in 28 (3.0%), HI-2 in 124 (13.1%), PH-1 in 48 (5.1%), PH-2 in 57 (6.0%) and Extra-parenchymal hemorrhage in 39 (4.1%). After adjusting for confounders, tirofiban treatment was strongly associated with increased risk of PH-2 (adjusted relative risk [RR] 1.77, 95% CI 1.04-3.03, P=0.036) and any radiologic ICH (adjusted RR 1.25, 95% CI 1.04-1.51, P=0.018) compared with placebo. Exploratory analyses found cardioembolic stroke (P =0.031) harbored a higher PH-2 risk when they received tirofiban treatment. CONCLUSIONS: Intravenous tirofiban preceding EVT significantly increased PH-2 risk in large vessel occlusive stroke. Cardioembolic stroke might be associated with PH-2 risk for patients receiving tirofiban before EVT.
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