Impact of Preemptive vs. Conventional Tirofiban Administration on the Outcomes in Acute Branch Atheromatous Disease: A Propensity Score-Weighted Cohort Study.
Li C, Jin Y, et al. • CNS neuroscience & therapeutics • 2026
Preemptive administration of tirofiban within the initial 72 hours significantly improves 90-day neurological outcomes and reduces hospital stay length in patients with BAD-related stroke compared to reactive rescue therapy following early neurological deterioration.
Key Findings
Results
Preemptive tirofiban administration resulted in a significantly higher rate of excellent 90-day outcomes compared to conventional intervention.
After IPTW adjustment, the preemptive intervention group showed an excellent 90-day outcome rate of 76.6% versus 44.6% in the conventional group (p < 0.001).
Excellent 90-day outcome was defined as a modified Rankin Scale (mRS) score ≤ 1.
Inverse probability of treatment weighting (IPTW) was applied to balance baseline covariates between groups.
The study enrolled 221 patients with BAD-associated stroke: 127 in the preemptive group and 94 in the conventional group.
Results
Preemptive tirofiban administration was associated with a shorter median hospital stay compared to conventional intervention.
After IPTW adjustment, median hospital stay was 10 days in the preemptive group versus 11 days in the conventional group (p = 0.02).
Preemptive intervention was defined as administration after clinical risk assessment within 72 hours.
Conventional intervention was delayed until an increase of ≥ 2 points on the NIHSS score (i.e., rescue therapy following early neurological deterioration).
Results
No significant between-group differences were observed in mortality or stroke recurrence.
Mortality and stroke recurrence rates did not differ significantly between the preemptive and conventional intervention groups (p > 0.05 for both).
This suggests the improved functional outcomes with preemptive tirofiban were not accompanied by increased safety risks in terms of death or recurrent stroke.
Results
Early tirofiban use and lower baseline NIHSS score were identified as independent predictors of favorable 90-day outcomes.
Early tirofiban use independently predicted favorable outcomes with an adjusted OR of 4.411 (95% CI: 2.349–8.283).
Lower baseline NIHSS score also independently predicted favorable outcomes with an adjusted OR of 0.832 (95% CI: 0.707–0.980).
Multivariable regression analysis was used to identify these independent predictors.
Favorable outcome was defined as mRS score ≤ 1 at 90 days.
Results
Patients aged over 65 years derived greater neuroprotection from preemptive tirofiban compared to younger patients.
Subgroup analyses revealed a statistically significant age-treatment interaction (p = 0.004 for age-treatment interaction).
Patients aged over 65 years showed greater benefit from preemptive tirofiban administration.
Subgroup analyses confirmed consistent benefits across most other strata examined.
Methods
This was a retrospective, single-center propensity score-weighted cohort study of patients with branch atheromatous disease (BAD)-associated stroke.
A total of 221 patients with BAD-associated stroke were enrolled.
Patients were assigned to a preemptive intervention group (n = 127) or a conventional intervention group (n = 94) based on timing of tirofiban administration.
IPTW was applied to balance baseline covariates between groups.
The primary outcome was excellent 90-day neurological outcome defined as mRS score ≤ 1.
Branch atheromatous disease carries a high risk of early neurological deterioration (END).
What This Means
Branch atheromatous disease (BAD) is a type of stroke caused by the blockage of small blood vessels branching off larger arteries, and it carries a particularly high risk of early worsening of neurological symptoms. This study examined whether giving patients a platelet-inhibiting drug called tirofiban early (within 72 hours, based on clinical risk assessment) would work better than waiting until patients actually showed signs of worsening (defined as a 2-point increase on a standard neurological severity scale). The study followed 221 patients and used statistical methods to make the two groups comparable.
The research found that patients who received tirofiban early had much better neurological outcomes at 90 days — about 77% achieved excellent recovery (minimal or no disability) compared to about 45% in the group that only received tirofiban after showing deterioration. The early-treatment group also had shorter hospital stays (10 days vs. 11 days on average). Importantly, there were no differences between the groups in rates of death or stroke recurrence, suggesting the early approach did not increase safety risks. Patients older than 65 years appeared to benefit even more from early tirofiban treatment.
This research suggests that proactively administering tirofiban to BAD stroke patients based on clinical risk factors — rather than waiting for neurological worsening to occur — may substantially improve recovery and reduce time in the hospital. The findings highlight that timing of treatment may be critical in this type of stroke, and that older patients in particular might stand to gain the most from an early intervention strategy. However, as a single-center retrospective study, these results would benefit from confirmation in larger, prospective, randomized trials.
Li C, Jin Y, Liu X, Liu Y, Yang W, Wang Y, et al.. (2026). Impact of Preemptive vs. Conventional Tirofiban Administration on the Outcomes in Acute Branch Atheromatous Disease: A Propensity Score-Weighted Cohort Study.. CNS neuroscience & therapeutics. https://doi.org/10.1002/cns.71120