ESOC 2026 | Findings from the INSTANT trial: intravenous tirofiban after tenecteplase in acute ischemic stroke

The INSTANT trial was a multicenter randomized double-blind trial conducted at 37 centers across China. And it was designed to assess the efficacy and the safety of intravenous tirofiban following an inadequate clinical response to intravenous tenecteplase in patients with acute ischemic stroke. And the study population was a patient with acute ischemic stroke with a large or medium vessel occlusion of cardioembolic source and inadequate response to tenecteplase. And we enrolled 359 patients and 177 patients were assigned to the tirofiban group and 182 patients to the placebo group. And the intervention with tirofiban is 0.3 milligram per kilogram per minute bolus over 30 minutes. And then 0.075 milligram per kilogram per minute up to 47.5 hours. And the key findings were the proportions of excellent outcome in the tirofiban group was 63.8% and was 52.2% in the placebo group. And the secondary outcome was tirofiban significantly improved the ordinal mRS shift. And the safety outcomes were the rate of symptomatic intracranial hemorrhage was extremely low. It’s about 0.9% in the tirofiban group. And in conclusion, among acute ischemic stroke patients with a large or medial vessel occlusion or cardioembolic who had an inadequate response to tenecteplase. Injecting intravenous tirofiban significantly improved the rate of excellent outcome at 90 days and without increasing the major bleeding or mortality.

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