Tirofiban plus aspirin associated with lower early neurological deterioration in branch atheromatous disease

This retrospective single-center cohort study compared early administration of tirofiban plus aspirin (T + A) versus dual antiplatelet therapy (DAPT) in patients with acute branch atheromatous disease. The primary outcomes were early neurological deterioration (END) within 7 days and excellent functional outcome (modified Rankin Scale 0–1) at 90 days. The sample size was not reported.

For the primary outcome of END within 7 days, the T + A group showed END in 10.1% of patients compared to 55.1% in the DAPT group. The adjusted odds ratio was 0.08 (95% confidence interval 0.03–0.20), indicating a strong association favoring the tirofiban regimen. The p value was not reported. Secondary outcomes included favorable outcome (mRS 0–2) and early neurological improvement, but specific results for these endpoints were not provided.

Safety and tolerability data were not reported, including adverse events, serious adverse events, and discontinuation rates. Key limitations include the retrospective design, single-center setting, and lack of reported safety information. The study design cannot establish causation, only association.

For clinical practice, these findings suggest tirofiban plus aspirin may warrant investigation as a potential approach for preventing early neurological deterioration in this specific stroke subtype. However, the retrospective nature, absence of safety data, and single-center origin preclude definitive conclusions. Prospective randomized trials are needed to confirm these observations and establish safety profiles before any clinical recommendations can be made.