Tirofiban With Sequential Dual Antiplatelet Therapy in Mild Stroke

Prior treatment

• Received or planned to receive intravenous thrombolysis or bridging therapy (with subsequent endovascular treatment)
• Major surgery within 14 days.

Other illness

• Intracranial hemorrhage confirmed by imaging.
• Pre-stroke modified Rankin Scale (mRS) score ≥2.
• History of primary intracerebral hemorrhage.
• History of other intracranial hemorrhage (intraventricular, subarachnoid, epidural, or subdural hemorrhage).
• Major systemic bleeding within 30 days.
• Known allergy or contraindication to tirofiban or aspirin.
• Any terminal illness with life expectancy \<6 months.

Lab values

• Any confirmed cardioembolic source, including chronic or paroxysmal atrial fibrillation, sick sinus syndrome, mitral stenosis, mechanical heart valve, infective endocarditis, intracardiac thrombus or vegetation, myocardial infarction within 3 months, dilated cardiomyopathy, left atrial spontaneous echo contrast, ejection fraction \<30%.
• Active bleeding, including laboratory evidence of coagulopathy (platelet count \<100 × 10⁹/L, activated partial thromboplastin time \>50 seconds, or international normalized ratio \>1.7), or treatment with direct oral anticoagulants within the preceding 48 hours.
• Baseline platelet count \<100 × 10⁹/L.
• Severe renal dysfunction (glomerular filtration rate \<30 mL/min or serum creatinine \>220 μmol/L \[2.5 mg/dL\]).

Other

• Untreated or inadequately treated intracranial aneurysm or vascular malformation.
• Persistently elevated blood pressure (systolic \>180 mmHg or diastolic \>110 mmHg) despite treatment.
• Current pregnancy or lactation.
• Any intracranial tumor (except asymptomatic meningiomas ≤1.5 cm in diameter).

• Age: 18-80 years old.
• Acute mild non-cardioembolic stroke.
• NIHSS score ≤5.
• Time from onset to randomization of ≤48 hours; if the time of onset is unknown, time from the last known time of being well to randomization of ≤48 hours.
• The investigational drug can be administered within 48 hours of symptom onset.
• Signed informed consent by the patient or legally authorized representative.