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The STRATEGY trial assessed whether adding intravenous tirofiban to aspirin could reduce early neurological deterioration (END) or recurrent stroke in patients with branch atheromatous disease-related acute ischemic stroke. This multicentre, double-blind randomized trial was conducted across 38 hospitals in China and enrolled 970 patients, with 486 assigned to tirofiban plus aspirin and 484 to placebo plus aspirin. Tirofiban was administered as a 30-minute loading infusion followed by a 24-hour maintenance infusion; all patients received aspirin. The primary efficacy outcome was END within seven days or a new stroke within 90 days, while the primary safety outcome was moderate or severe bleeding. The primary efficacy outcome occurred in 79 patients (17.1%) in the tirofiban group and 89 (19.6%) in the placebo group; the difference was not statistically significant (hazard ratio, 0.88; 95% CI, 0.65–1.19; P = 0.39). Moderate or severe bleeding occurred in one patient (0.2%) receiving tirofiban and none receiving placebo (P > 0.99). Conclusion: Adding intravenous tirofiban to aspirin did not significantly reduce early neurological deterioration or new stroke in this patient population, although moderate or severe bleeding was uncommon in both groups. The findings do not support routine use of this regimen for all patients with branch atheromatous disease-related stroke.
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The STRATEGY trial assessed whether adding intravenous tirofiban to aspirin could reduce early neurological deterioration (END) or recurrent stroke in patients with branch atheromatous disease-related acute ischemic stroke. This multicentre, double-blind randomized trial was conducted across 38 hospitals in China and enrolled 970 patients, with 486 assigned to tirofiban plus aspirin and 484 to placebo plus aspirin. Tirofiban was administered as a 30-minute loading infusion followed by a 24-hour maintenance infusion; all patients received aspirin. The primary efficacy outcome was END within seven days or a new stroke within 90 days, while the primary safety outcome was moderate or severe bleeding. The primary efficacy outcome occurred in 79 patients (17.1%) in the tirofiban group and 89 (19.6%) in the placebo group; the difference was not statistically significant (hazard ratio, 0.88; 95% CI, 0.65–1.19; P = 0.39). Moderate or severe bleeding occurred in one patient (0.2%) receiving tirofiban and none receiving placebo (P > 0.99). Conclusion: Adding intravenous tirofiban to aspirin did not significantly reduce early neurological deterioration or new stroke in this patient population, although moderate or severe bleeding was uncommon in both groups. The findings do not support routine use of this regimen for all patients with branch atheromatous disease-related stroke.
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