ADJUVANT Trial: Intravenous Tirofiban Versus Thrombolysis Before Endovascular Stroke Thrombectom

04 Mar 20264 min read0 viewsJournal Feed

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Journal of the American Heart Association, Volume 15, Issue 6 , March 17, 2026. BackgroundIntravenous thrombolysis followed by endovascular thrombectomy (EVT) is a first‐line recommended strategy for thrombolysis‐eligible patients with stroke due to acute large‐vessel occlusion.

Tirofiban, one of the most used glycoprotein IIb/IIIa receptor inhibitors, has been increasingly advocated to counteract different stages of thrombosis mediated by activated platelets. It is unclear whether tirofiban could be used as an alternative to thrombolysis as adjuvant medicine for EVT.

This trial aims to assess whether intravenous tirofiban plus EVT is noninferior to intravenous thrombolysis bridging with EVT in patients with acute ischemic stroke due to large‐vessel occlusion who are eligible for thrombolysis.MethodsADJUVANT (Intravenous Tirofiban Versus Thrombolysis Before Endovascular Stroke Thrombectomy) is an investigator‐initiated, multicenter, randomized, open‐label, noninferiority trial with blinded end point assessment conducted at 42 thrombectomy‐capable centers in China.

Clinical Editorial

Study Focus and Objective

The ADJUVANT trial investigates whether intravenous tirofiban plus endovascular thrombectomy (EVT) is noninferior to intravenous thrombolysis bridging with EVT in thrombolysis-eligible patients with acute ischemic stroke due to large-vessel occlusion.
Tirofiban is a glycoprotein IIb/IIIa inhibitor considered for modulation of thrombosis at multiple platelet-activation stages; its role as an alternative adjuvant to thrombolysis remains to be defined.

Design and Setting

ADJUVANT is an investigator-initiated, multicenter, randomized, open-label trial with blinded endpoint assessment.
The study is conducted at 42 thrombectomy-capable centers in China.
Randomization uses a 2:1 ratio to tirofiban plus EVT versus intravenous thrombolysis bridging with EVT.

Population and Eligibility

Participants are adults with acute ischemic stroke who are thrombolysis-eligible and have imaging-confirmed occlusion of the internal carotid artery, or M1/M2 segments of the middle cerebral artery, or basilar artery.
Enrolment targets 976 participants.

Interventions Compared

Experimental arm: intravenous tirofiban followed by EVT.
Control arm: standard intravenous thrombolysis followed by EVT (bridging therapy).

Primary and Secondary Outcomes

Primary efficacy outcome: functional independence at 90 days, defined by modified Rankin Scale scores 0–2.
Safety outcomes include symptomatic intracranial hemorrhage within 48 hours and mortality within 90 days.

Context and Relevance

The trial seeks to generate evidence on whether adjuvant tirofiban before EVT can match or approach the outcomes of the current standard of care involving thrombolysis bridging.
Registration and trial identifiers are provided, with ClinicalTrials.gov identifier NCT05728333.

Limitations and Reporting Considerations

The provided information outlines design, endpoints, and scope but does not include results, interim analyses, or effect estimates.
As a protocol description, explicit outcome data, subgroup analyses, or practical implications are not reported in this source.