Discussion
bleeding, sICH, cardioembolic, cardioembolic stroke, platelet aggregation
BLEEDING
This paper reports on a post hoc analysis of the RESCUE BT randomized trial, which aimed to investigate the efficacy of tirofiban for patients presenting with cardioembolic LVO within 24 h of onset. The results demonstrated that the administration of intravenous tirofiban prior to EVT didn’t improve the rate of functional independence at 90 days. However, the use of tirofiban in cardioembolic stroke patients undergoing endovascular therapy was associated with an increased risk of sICH compared to placebo. These findings suggest that tirofiban may be a harmful adjunct to endovascular therapy for patients with cardioembolic LVO.The occurrence of sICH associated with antithrombotic drugs in endovascular therapy is a well-known concern [The increased risk of sICH associated with tirofiban administration in cardioembolic stroke patients undergoing endovascular therapy can be attributed to several factors. Firstly, tirofiban's mechanism of action involves inhibiting platelet aggregation, which can lead to prolonged bleeding time and impaired hemostasis [This study possesses several limitations that should be considered when interpreting the findings. Firstly, the analysis was conducted as a post hoc analysis within the RESCUE BT trial, which may introduce inherent limitations and potential biases. This study might have been underpowered to detect a significant treatment effect within the specific subgroup of patients with cardioembolic stroke. Larger-scale randomized controlled trials specifically focusing on this patient population are essential to further validate our findings. Secondly, the tirofiban group exhibited a significantly longer time from symptom onset to randomization, leading to a delayed time to reperfusion, although the difference in the time from symptom onset to reperfusion did not reach statistical significance. Previous studies have shown that a prolonged time from symptom onset to reperfusion in patients undergoing endovascular therapy within 6 h is associated with unfavorable outcomes [