Letter to the editor regarding: "Tirofiban vs. aspirin in patients with acute ischemic stroke: A meta-analysis of randomized clinical trials"

The article by De Oliveira et al. presents an insightful systematic review and meta analysis comparing intravenous tirofiban and oral aspirin in acute ischemic stroke (AIS) patients. It has sparked substantial discussions among my colleagues and me, particularly regarding the optimal circumstances for administering intravenous tirofiban in AIS patients ineligible for reperfusion therapies. The meta-analysis's focus on randomized clinical trials, all conducted in China, raises important questions about the generalizability of its findings to other ethnicities and populations worldwide. In this commentary, we commend the authors for their rigorous analysis and for addressing a topic of critical importance to neurologists and neurointerventionists globally. We aim to extend the discussion by exploring key considerations such as ethnic variability, cost-effectiveness, and the nuanced factors influencing treatment decisions, including NIHSS scores, collateral circulation, and AIS etiology. These insights could play a pivotal role in guiding future research and shaping evidence based guidelines for AIS management.