Tirofiban after stroke thrombectomy improved recovery in a large China trial
In ATTRACTION, tirofiban given after successful thrombectomy left more stroke patients independent at 90 days than placebo, though symptomatic brain bleeds trended higher and were not significantly different.
| Group | Value (%) |
|---|---|
| Tirofiban | 49 |
| Placebo | 43 |
Pulling a clot out of a blocked brain artery has become routine care for one of the most disabling kinds of stroke. But opening the vessel is not the same as saving the brain: even after a technically successful thrombectomy, many patients do not recover the ability to live independently [s1]. That gap is what the ATTRACTION trial set out to narrow.
ATTRACTION, published in The Lancet on 24 June, tested whether adding tirofiban — a glycoprotein IIb/IIIa receptor antagonist that blocks platelets from clumping — after a good reperfusion could push more patients toward a good outcome [s1].
What the trial did
This was a multicentre, double-blind, randomised controlled trial run at 82 hospitals in China [s1]. It enrolled patients whose stroke was caused by an anterior-circulation large-vessel occlusion and who had already achieved a successful reperfusion after thrombectomy [s1]. Patients were randomly assigned 1:1 to tirofiban or to a placebo given at the same volume and by the same bolus-and-infusion procedure, so that patients, treating clinicians, investigators and outcome assessors were all masked [s1].
The tirofiban regimen was an intra-arterial bolus of 5 micrograms per kilogram followed by an intravenous infusion of 0.1 micrograms per kilogram per minute for 24 hours [s1]. The primary efficacy outcome was functional independence at 90 days, defined as a modified Rankin Scale score of 0 to 2, and it was assessed in everyone randomly assigned — the intention-to-treat population [s1].
Between April 9, 2024, and Sept 29, 2025, of 1686 patients assessed, 1380 were randomised: 689 to tirofiban and 691 to placebo [s1]. The median age was 71 years, 43% of patients were female, and 99% were of Han Chinese ethnicity [s1]. No patients were lost to follow-up at 90 days — an unusually complete dataset [s1]. The trial is registered as NCT06265051 and is now completed [s1] [s2].
What happened
Functional independence at 90 days was recorded in 340 of 689 patients (49%) in the tirofiban group and 299 of 691 patients (43%) in the placebo group [s1]. That is an unadjusted absolute risk difference of 6.1 percentage points (95% CI 0.8 to 11.3, p=0.023), and an adjusted risk ratio of 1.15 (95% CI 1.03 to 1.27, p=0.0092) [s1].
The lower bound of that confidence interval sits just above zero, at 0.8 percentage points [s1]. The result is statistically significant, but the interval reaches from a barely detectable benefit up to roughly 11 percentage points [s1]. It is a positive trial, not a decisive one.
The safety signal to read carefully
Any drug that thins the blood after a stroke raises the same worry: bleeding into the injured brain. Here the numbers moved in the wrong direction but did not reach significance [s1].
Symptomatic intracranial haemorrhage within 48 hours occurred in 82 of 687 patients (12%) on tirofiban versus 65 of 691 (9%) on placebo [s1]. Any intracranial haemorrhage on imaging within 48 hours occurred in 235 patients (34%) versus 219 (32%) [s1]. Death within 90 days was 126 patients (18%) with tirofiban and 131 (19%) with placebo [s1].
The investigators' own interpretation is measured: symptomatic haemorrhage occurred numerically more often with tirofiban, and the between-group difference was not significant, but the finding "warrants caution when weighing potential benefit against bleeding risk" [s1]. A trend that does not reach significance is not the same as a trend that has been ruled out.
Who paid, and where it was done
Two features matter for how far these results travel. First, this was an academic, investigator-led trial funded by the Tongji Hospital Clinical Research Fund rather than by the drug's manufacturer [s1] — an independent test, not a company registration study. Second, it was conducted entirely in China, in a population that was 99% Han Chinese [s1]. Stroke care, imaging thresholds and patient characteristics differ across health systems, so whether the same 6.1-point benefit appears elsewhere is an open question [s1].
What to watch
The immediate question for guideline writers is whether a benefit whose confidence interval starts at 0.8 percentage points, paired with a non-significant excess of symptomatic bleeds, is enough to change practice [s1]. Adjunctive antiplatelet therapy after thrombectomy has been studied before with mixed results, and ATTRACTION adds a large, clean, fully followed-up positive signal to that literature — without settling the bleeding trade-off [s1].
The next step is replication outside China and a clearer read on which patients gain most and which face the highest bleeding risk [s1].
This article describes trial results. It is not advice about any medicine, and nothing here should be used to start, stop or change treatment.
Sources
- Efficacy and safety of tirofiban after successful endovascular reperfusion in acute ischaemic stroke (ATTRACTION) in China, The Lancet, 24 June 2026
- ATTRACTION trial registration (NCT06265051), ClinicalTrials.gov, first posted 20 February 2024
Sources
- Efficacy and safety of tirofiban after successful endovascular reperfusion in acute ischaemic stroke (ATTRACTION) in China: a multicentre, double-blind, randomised controlled trial — The Lancet , June 24, 2026
- Adjunct Tirofiban Treatment After Successful Mechanical Thrombectomy in Acute Anterior Circulation Ischaemic Stroke (ATTRACTION), NCT06265051 — ClinicalTrials.gov , February 20, 2024
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