Real-world comparison of tirofiban versus aspirin in acute non-large-vessel occlusion ischemic stroke: A retrospective cohort study

Background: Acute non-large-vessel occlusive ischemic stroke (ANLVOIS) is a common subtype of stroke. The core of treatment is to rapidly improve cerebral perfusion and reduce neurological injury. Aspirin is used in the acute phase, but its efficacy is limited in some patients. Tirofiban (a highly selective glycoprotein IIb/IIIa receptor antagonist) is widely used and there are few direct comparative studies of its efficacy and safety with those of the other drugs. Objectives: To compare the clinical efficacy and safety of the antiplatelet drugs tirofiban and aspirin in the treatment of ANLVOIS. Methods: This retrospective controlled study collected clinical data of ANLVOIS patients from Wuqiao County People's Hospital (Jan 2023–Dec 2024), grouped by treatment: Group A (n=55, aspirin alone) and Group B (n=58, tirofiban bridging to aspirin). NIHSS scores (pre-treatment, 1 week, and 3 months post-treatment) were analyzed for neurological function, and 3-month mRS scores were analyzed for prognosis. 90-day all-cause mortality, symptomatic intracranial hemorrhage (sICH) incidence and adverse event rate were compared. Statistical analyses were performed using SPSS 26.0. Results: Baseline characteristics were balanced between the two groups (P>0.05). At 7 days and 3 months post-treatment, NIHSS and mRS scores decreased significantly in both groups (P<0.05), with Group B having notably lower scores than Group A (P<0.05). The 90-day all-cause mortality, sICH incidence and adverse event rates were 1.7%, 3.4%, and 6.9% in Group B, respectively, compared with 3.6%, 5.5%, and 16.4% in Group A, with no significant intergroup differences (P>0.05). Conclusion: In this retrospective analysis, early treatment with tirofiban followed by aspirin was associated with better neurological and functional outcomes in ANLVOIS than aspirin alone, while maintaining a comparable safety profile. These real-world findings support the use of tirofiban-based induction as an effective acute-phase antiplatelet strategy.