Tirofiban for Patients Treated With Alteplase

A Prospective, Multicenter, Randomized, Double-blind, Placebo-controlled Clinical Trial of Early Administration of Tirofiban in Acute Ischemic Stroke Patients Treated With Intravenous Alteplase Thrombolysis

After intravenous thrombolysis, the overall recanalization rate is 46%, and recclusion after initial recanalization occurs in 14-34%. In the MR TEA, the investigators compared the effects of administration of tirofiban in acute ischemic stroke patients treated with intravenous alteplase thrombolysis with alteplase alone.

Inclusion Criteria:

• Age ≥18
• Ischemic stroke symptom with onset ≤4.5 hours treated with IV rt-PA according with local guidelines.
• 6≤ NIHSS ≤20 before IV tPA, or NIHSS >20 but decrease ≥ 8 after IV rt-PA.
• ≥ 4 point total NIHSS or ≥ 2 point in one NIHSS category during and after the IV rt-PA compared to immediately before worsening, an emergency CT scan should be performed to exclude intracranial hemorrhage
• Patients or their legally acceptable representative agreed to the treatment and signed the informed consent form

Exclusion Criteria:

• Patients whom the treating physician is planning to treat with mechanical thrombectomy or other endovascular procedure (e.g. Intra-arterial thrombolysis) according with local guidelines.
• Patients had used antiplatelet therapy in the past 5 days before the stroke.
• Patients had used anticoagulant therapy in the past 5 days before the stroke.
• Scheduled for surgery or interventional treatment requiring study drug cessation.
• CT scan finding of hypoattenuation involving ≥1/3 of the MCA territory.
• Any evidence of clinically significant bleeding ,or known coagulopathy.
• Renal insufficiency (creatinine clearance rate <30ml/min)
• Hepatic dysfunction (ALT >2 folds of Upper limit of normal value or AST>2 folds of Upper limit of normal value).
• Pre-existing disability with ≥ mRS 2.
• Known allergic to tirofiban or other glycoprotein IIb/IIIa antagonist.
• Severe non-cerebrovascular disease with life expectancy <3 months