These Blood Tests May Detect Dozens of Cancers, but Will They Save Lives?

# These Blood Tests May Detect Dozens of Cancers, but Will They Save Lives? *Published: 2026 May 8* Intravenous Tirofiban After Tenecteplase in Acute Ischemic Stroke: The INSTANT Randomized Clinical Trial. INSTANT Trial Authors for the INSTANT Investigators; Liu X(1)(2), Zhang F(1)(2), Zhang C(1)(2), Li Z(3), Yuan G(4), Kong D(5), Xie S(1)(2), Zhou M(1)(2), Ye J(1)(2), Lai Z(1)(2), Li D(6), Xu H(7), Chen L(3), Cheng F(4), Shi Y(8), Chen B(9), Hu W(10), Liu H(11), Yin Y(12), Deng X(13), Xie Z(14), Li C(15), Shi J(16), Mei D(17), Liu B(18), Wang B(19), Zhou R(20), Liu J(21), Shen L(22), Hu H(23), Xiao G(24), Guan X(25), Yuan S(26), Lv X(27), Liang S(28), Zeng X(29), Chen Y(30), Cao W(31), Zheng C(32), Liu Y(1)(2), Li J(1)(2), Guan B(1)(2), Lai T(1)(2), Sun W(1)(2), Zeng H(1)(2), Zhang J(5), Li S(33), Sang H(34), Tang Y(35), Wang D(36), Lu M(37), Kaesmacher J(38), Yogendrakumar V(39)(40), Pan S(41), Nogueira RG(42), Hong D(43), Goyal M(44), Thomalla G(45), Nguyen TN(46), Saver JL(47), Yang Q(48), Qiu Z(35), Zeng G(1)(2). Author information: (1)Department of Neurology, The Affiliated Ganzhou Hospital of Nanchang University (Ganzhou People's Hospital), Ganzhou, China. (2)Ganzhou Hospital-Nanfang Hospital, Southern Medical University (Ganzhou People's Hospital), Ganzhou, China. (3)Department of Neurology, Mingguang People's Hospital, Chuzhou, China. (4)Department of Emergency, Xiangtan Central Hospital (The Affiliated Hospital of Hunan University), Xiangtan, China. (5)Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China. (6)Department of Neurology, Zhongmeng Hospital of Hexigten Banner, Chifeng, China. (7)Department of Neurology, Yiling People's Hospital of Yichang City, Yichang, China. (8)Department of Neurology, People's Hospital of Xinfeng County, Xinfeng, China. (9)Department of Neurology, People's Hospital of Quannan County, Quannan, China. (10)Department of Neurology, People's Hospital of Ganxian District, Ganzhou, China. (11)Department of Neurology, People's Hospital of Dayu County, Dayu, China. (12)Department of Neurology, People's Hospital of Shangyou County, Shangyou, China. (13)Department of Neurology, People's Hospital of Yichun, Yichun, China. (14)Department of Neurology, People's Hospital of Yudu County, Yudu, China. (15)Department of Neurology, Songyuan Jilin Oilfield Hospital, Songyuan, China. (16)Department of Neurology, Huangmei People's Hospital, Huangmei, China. (17)Department of Neurology, People's Hospital of Xunwu County, Xunwu, China. (18)Department of Neurology, People's Hospital of Wan'an County, Wan'an, China. (19)Department of Neurology, Hunan Xupu Chengnan Hospital, Huaihua, China. (20)Department of Neurology, People's Hospital of Ruijin City, Ruijin, China. (21)Department of Neurology, Yingtan People's Hospital, Yingtan, China. (22)Department of Neurology, People's Hospital of Shaodong, Shaodong, China. (23)Department of Neurology, People's Hospital of Ningdu County, Ningdu, China. (24)Department of Neurology, People's Hospital of Shicheng County, Shicheng, China. (25)Department of Neurology, Second People's Hospital of Yudu County, Yudu, China. (26)Department of Neurology, Second Hospital of Xingguo County, Xingguo, China. (27)Department of Neurology, People's Hospital of Chongyi County, Chongyi, China. (28)Department of Neurology, Traditional Chinese Medicine Hospital of Xingguo County, Xingguo, China. (29)Department of Neurology, Hunan University of Medicine Affiliated Pingjiang Hospital (Pingjiang County First People's Hospital), Pingjiang, China. (30)Department of Neurology, Ji'an Central People's Hospital, Ji'an, China. (31)Department of Neurology, Jiangxi Provincial People's Hospital, Nanchang, China. (32)Department of Neurology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China. (33)Department of Neurology, First People's Hospital of Yulin, Yulin, China. (34)Department of Neurology, Hangzhou First People's Hospital and School of Medicine of Westlake University, Hangzhou, China. (35)Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China. (36)Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. (37)Health Science Center, Ningbo University, Ningbo, China. (38)University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland. (39)Division of Neurology, Ottawa Hospital and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. (40)Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia. (41)Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China. (42)UPMC Stroke Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. (43)Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China. (44)Departments of Radiology and Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada. (45)Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. (46)Department of Neurology, Boston Medical Center, Boston. (47)Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles. (48)Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China. Comment in doi: 10.1001/jama.2026.5288. doi: 10.1001/jama.2022.12584. doi: 10.1001/jamaneurol.2023.5093. ## IMPORTANCE Although recent trials have shown benefit with early tirofiban after thrombolysis, its efficacy remains uncertain in patients with acute ischemic stroke who do not have a large or medium vessel occlusion or a cardioembolic source and who show an inadequate clinical response to intravenous tenecteplase. ## OBJECTIVE To assess the efficacy and safety of intravenous tirofiban administered after an inadequate response to intravenous tenecteplase in this specific patient population. DESIGN, SETTING, AND PARTICIPANTS Investigator-initiated, randomized, double-blind, placebo-controlled trial conducted at 37 hospitals in China, enrolling 359 patients with acute ischemic stroke, without large or medium vessel occlusion or cardioembolic etiology, and with an insufficient clinical response to intravenous tenecteplase (defined as no significant change from baseline, neurological deterioration, or neurological fluctuation based on serial assessment of the National Institutes of Health Stroke Scale score within 4-24 hours after infusion). Recruitment took place between April 24, 2024, and July 16, 2025, with final follow-up on October 11, 2025. ## INTERVENTIONS Intravenous tirofiban (n = 177), administered as a 0.3-μg/kg/min bolus over 30 minutes, followed by a continuous infusion of 0.075 μg/kg/min for up to 47.5 hours, or matching placebo (n = 182), initiated within 4 to 24 hours after intravenous tenecteplase. Oral antiplatelet therapy (aspirin and/or clopidogrel) was started 24 hours after thrombolysis in the placebo group and 44 hours after thrombolysis in the tirofiban group and continued in all patients through 90-day follow-up. MAIN OUTCOMES AND MEASURES The primary outcome was an excellent outcome (defined as a score of 0 or 1 on the modified Rankin Scale; range, 0-6, with higher scores indicating more severe disability) at 90 days. Safety outcomes included incidence of symptomatic intracranial hemorrhage within 48 hours and 90-day mortality. ## RESULTS Among 359 patients randomized (mean age, 66 years; 141 females [39.3%]), 358 (99.7%) completed the trial. An excellent outcome at 90 days was observed in 113 patients (63.8%) in the tirofiban group and in 95 patients (52.2%) in the placebo group (risk ratio, 1.22; 95% CI, 1.02-1.46; P = .03). Symptomatic intracranial hemorrhage within 48 hours occurred in 1 patient (0.9%) in the tirofiban group and no patients in the placebo group; 90-day mortality was 0.6% and 1.6%, respectively. CONCLUSIONS AND RELEVANCE Among patients with acute ischemic stroke without large or medium vessel occlusion or a cardioembolic source who had an inadequate clinical response to intravenous tenecteplase, adjunctive intravenous tirofiban increased the likelihood of an excellent outcome at 90 days. ## TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05604638. DOI: 10.1001/jama.2026.5245 PMCID: PMC13156798 DOI: 10.1001/jama.2026.4742