Journal Publication

RESCUE BT trial ties pre-EVT tirofiban to higher parenchymal hematoma risk in stroke

A secondary analysis of the RESCUE BT trial found intravenous tirofiban before endovascular therapy raised the risk of parenchymal hematoma type 2 and any radiologic hemorrhage versus placebo.

A RESCUE BT secondary analysis found intravenous tirofiban before endovascular treatment for anterior circulation stroke increased radiologic intracranial hemorrhage, particularly parenchymal hematoma type 2, compared with placebo.

By AppliedXLJuly 15, 2026

Executive Summary

A randomized, placebo-controlled analysis asked whether giving intravenous tirofiban before endovascular treatment for acute anterior circulation stroke changes the type and severity of resulting intracranial bleeding.
Tirofiban was associated with a higher rate of the most severe hemorrhage subtype and with radiologic hemorrhage overall, compared with placebo, after adjusting for confounders.
The excess bleeding risk concentrated in patients with cardioembolic stroke, a subgroup identified through exploratory interaction testing rather than a prespecified comparison.
The result sharpens how clinicians and trialists classify and anticipate bleeding risk when antiplatelet therapy precedes mechanical clot retrieval, without establishing a new efficacy or treatment claim.

The question

Intracranial hemorrhage is a recognized complication of endovascular treatment (EVT) for large vessel occlusive stroke, and clinicians have debated whether periprocedural glycoprotein IIb/IIIa inhibition with tirofiban adds to that risk. The RESCUE BT trial tested this directly by randomizing stroke patients to intravenous tirofiban or placebo before EVT, then classifying the intracranial bleeding that followed by radiologic subtype. Effect

The design

Patients with acute large vessel occlusion of the anterior circulation were randomized 1:1 to tirofiban or placebo ahead of endovascular treatment. Follow-up imaging classified radiologic intracranial hemorrhage using the Heidelberg bleeding classification, which separates hemorrhagic infarction types 1 and 2, parenchymal hematoma types 1 and 2, and extra-parenchymal hemorrhage. Poisson regression estimated the association between tirofiban and each hemorrhage subtype after adjusting for confounders, and a prespecified exploratory analysis tested whether stroke subtype modified that association. Effect

The result

Radiologic intracranial hemorrhage developed in 296 of 945 patients (31.3%). Among those with hemorrhage, hemorrhagic infarction type 1 occurred in 28 patients (3.0%), hemorrhagic infarction type 2 in 124 (13.1%), parenchymal hematoma type 1 in 48 (5.1%), parenchymal hematoma type 2 in 57 (6.0%), and extra-parenchymal hemorrhage in 39 (4.1%). After adjustment, tirofiban carried an adjusted relative risk of 1.77 for parenchymal hematoma type 2 (95% CI 1.04-3.03, P=0.036) and 1.25 for any radiologic hemorrhage (95% CI 1.04-1.51, P=0.018), both versus placebo. Effect

The subgroup signal

An exploratory interaction analysis found that patients with cardioembolic stroke carried a higher parenchymal hematoma type 2 risk when treated with tirofiban than patients with other stroke mechanisms (P for interaction = 0.031). Because this comparison was not the trial's primary analysis, it identifies a hypothesis about which patients concentrate the bleeding risk rather than a confirmed treatment-effect modifier. Effect

What it means for practice

Parenchymal hematoma type 2 is the Heidelberg classification's most severe hemorrhage category, typically associated with mass effect and worse outcomes, which gives this specific association more weight than an increase in the milder hemorrhagic infarction subtypes would carry. The finding does not by itself establish that tirofiban worsens functional outcomes after stroke, since the analysis reported radiologic hemorrhage subtype, not disability or mortality endpoints. Effect

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