Advancing Stroke Safety and Efficacy Through Early Tirofiban Administration After Intravenous Thrombolysis (ASSET-IT)

Other illness

• Pre-stroke mRS score \> 1;
• Patients with a history of atrial fibrillation or emergency ECG indicating atrial fibrillation;
• If NIHSS worsens by 2 or more points between start of thrombolysis and start of study drug, repeat brain imaging rules out new intracranial hemorrhage;
• Known allergy to tirofiban or other IIb/IIIa inhibitors;

Lab values

• Known genetic or acquired bleeding diathesis, or received warfarin and INR \> 1.7; or treated with direct oral anticoagulant agents in the prior 48 hours;
• Severe renal failure, defined as serum creatinine \> 3.0 mg/dl (or 265.2 μmol/l) or glomerular filtration rate \[GFR\] \< 30, or patients requiring hemodialysis or peritoneal dialysis;
• Liver dysfunction (ALT \> 2 times the upper limit of normal or AST \> 2 times the upper limit of normal);

Other

• Presence of contraindications to intravenous thrombolysis;
• Patients planned to undergo mechanical thrombectomy or other endovascular treatments (e.g., intra-arterial thrombolysis);
• Pregnant or lactating women;
• NCCT, CTA source imaging, or MRI-DWI showing ASPECTS or PC-ASPECTS \< 6;
• Severe leukoaraiosis;
• Currently participating in other clinical trials;
• Life expectancy \< 1 year;
• Inability to complete 90-day follow-up (e.g., no fixed residence, overseas patients, etc.).

• Onset of ischemic stroke symptoms within ≤ 4.5 hours\*, treated with intravenous rt-PA or TNK according to guidelines;
• NIHSS score of 4-25 before intravenous thrombolysis;
• Age ≥ 18 years;
• Able to receive the designated study drug within 60 minutes after intravenous thrombolysis;
• Informed consent signed by the patient or their legal representative. \*Symptom onset is defined as the last known well time.