Abstract Body: Introduction: Tirofiban has shown a potential effect in reducing early neurological deterioration and improving clinical outcomes in selected patients with non-embolic stroke. We aim to analyze the effect of tirofiban versus standard acute therapy on 90-day outcomes in patients with presumed non-embolic stroke.

Methods: Multicentric retrospective cohort study including consecutive AIS patients presenting within 24h from symptom onset, baseline mRS 0-1, absence of cortical symptoms, identifiable vessel occlusion or other imaging features suggestive of embolic stroke; anticoagulated patients were excluded from the analysis. Patients received either tirofiban (±ASA) or standard acute therapy (IVT or oral antiplatelets). Primary outcome was functional independence at 90 days (mRS 0-2); secondary efficacy and safety outcomes included: excellent outcome (mRS 0-1); sICH, systemic bleeding and neurological deterioration (4 point increase in NIHSS). Exploratory subgroup analysis was performed for severity (NIHSS ≥5 vs <5) and standard therapy (IVT vs oral APT) groups.

Results: Of 290 patients included, 138 (48%) received tirofiban; 60(21%) IVT and 92(31%) oral antiplatelets. Median age was 63 (54-72) years, 65% were male, NIHSS at presentation was 5 (3-7). Baseline characteristics for each treatment group are summarized in the table. After adjusting by age, baseline mRS, NIHSS and time since onset, tirofiban was associated with higher odds of mRS 0-2 (93% vs 77%; aOR 3.7 [1.4-9.4]) and mRS 0-1(79% vs 59%; aOR 3.5 [1.7-6.9]). No sICH or severe systemic bleedings occurred in either group, minor bleedings included GI (T:1% vs ST:1%), hematuria (T:4% vs ST:0, p<0.01). Rate of neurological deterioration was T:0 vs ST:1%.
Tirofiban was associated with better outcomes irrespective of baseline NIHSS and control arm group (figure). Safety outcomes were not analyzed in subgroups due to low incidence of events.

Conclusion: Tirofiban is safe and may improve 90-day functional outcome in presumed non-embolic, non-LVO stroke, warranting further prospective randomized trials