Advancing Stroke Safety and Efficacy Through Early Tirofiban Administration After Intravenous Thrombolysis (ASSET-IT)

Inclusion Criteria: 1. Onset of ischemic stroke symptoms within ≤ 4.5 hours\*, treated with intravenous rt-PA or TNK according to guidelines; 2. NIHSS score of 4-25 before intravenous thrombolysis; 3. Age ≥ 18 years; 4. Able to receive the designated study drug within 60 minutes after intravenous thrombolysis; 5. Informed consent signed by the patient or their legal representative. \*Symptom onset is defined as the last known well time. Exclusion Criteria: 1. Presence of contraindications to intravenous thrombolysis; 2. Pre-stroke mRS score \> 1; 3. Patients planned to undergo mechanical thrombectomy or other endovascular treatments (e.g., intra-arterial thrombolysis); 4. Patients with a history of atrial fibrillation or emergency ECG indicating atrial fibrillation; 5. Pregnant or lactating women; 6. NCCT, CTA source imaging, or MRI-DWI showing ASPECTS or PC-ASPECTS \< 6; 7. If NIHSS worsens by 2 or more points between start of thrombolysis and start of study drug, repeat brain imaging rules out new intracranial hemorrhage; 8. Severe leukoaraiosis; 9. Currently participating in other clinical trials; 10. Known genetic or acquired bleeding diathesis, or received warfarin and INR \> 1.7; or treated with direct oral anticoagulant agents in the prior 48 hours; 11. Severe renal failure, defined as serum creatinine \> 3.0 mg/dl (or 265.2 μmol/l) or glomerular filtration rate \[GFR\] \< 30, or patients requiring hemodialysis or peritoneal dialysis; 12. Liver dysfunction (ALT \> 2 times the upper limit of normal or AST \> 2 times the upper limit of normal); 13. Known allergy to tirofiban or other IIb/IIIa inhibitors; 14. Life expectancy \< 1 year; 15. Inability to complete 90-day follow-up (e.g., no fixed residence, overseas patients, etc.).