To the Editor: We have read with great interest the article published by Zanaty et al1 entitled “Tirofiban Protocol Protects Against Delayed Cerebral Ischemia: A Case-Series Study,” in which the authors evaluate the safety and risk of delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage, who have received continuous treatment with tirofiban through the use of a flow diverter device or stent-assisted coiling. In the first instance, we want to congratulate the authors of the manuscript and highlight the innovative nature of this study because it provides new evidence regarding the management of complications secondary to pathological processes of high morbidity and mortality, as is aneurysmal subarachnoid hemorrhage. However, when analyzing the results obtained by the authors, a great controversy can be found regarding the previously published literature. A recently released systematic review and meta-analysis studied the impact of tirofiban on the management of stroke patients, in which they identified 17 studies, finally including 2914 patients.2 The authors of this research conclude that tirofiban is considered safe in systemic treatment and that it may represent a potential option for the management of cerebral ischemia. However, statistical analysis showed that the treated group had an increased risk of fatal intracranial hemorrhage (odds ratio [OR], 2.84; 95% CI, 1.38-5.85; P = .005), and the subgroup analysis showed a similar pattern of risk in those who were administered this compound via intra-arterial (OR, 2.90; 95% CI, 1.12-7.55; P = .03), but lower when administered intravenously (OR, 2.75; 95% CI, 0.92-8.20; P = .07). Considering the above, it is not compatible to support that tirofiban is safe in the management of cerebral ischemia because a satisfactory benefit/risk balance could not be evidenced.2 Kellert et al3 found similar results in a study with comparable objectives in which 50/162 patients treated with the same molecule were evaluated. They showed that fatal intracranial hemorrhage occurred more frequently in the intervened group (12.0% vs 2.7%; P = .03) and in patients with total anterior circulation infarct (13.3% vs 3.1%; P = .05).3 Additionally, they found that age (OR, 1.17; 95% CI, 1.00-1.37; P = .05) and use of tirofiban (OR, 3.03; 95% CI, 1.50-4.05; P = .04) were independent predictors of this complication and that the use of this compound was associated (OR, 6.60; 95% CI, 1.06-41.52; P = .04) with worse results overall.3 In this order, the authors concluded that the use of tirofiban in endovascular therapy has no benefit.3 Considering the heterogeneity in the results regarding the use of tirofiban, its postendovascular efficiency has generated concerns because of the insecurity of presenting fatal complications.3,4 In developing countries such as Colombia, stroke is among the leading causes of morbidity, mortality, and disability within the adult population.5 Unfortunately, very few clinical trials are conducted to investigate the impact of these types of compounds on delimited groups in the region. It would be of great value to conduct clinical trials in this and surrounding territories to seek answers to the myriad of questions about the effects of these drugs on the management of such a prevalent pathology.5 With tirofiban, the evolution and consequences of its mechanism of action in the Latin community could be analyzed because, for example, genetic factors compared to Caucasian, Asian, etc, may cause divergence in the benefit or risk of its use.6 Also, this type of study aims to ensure that governmental bodies propose and design public policies aimed at strengthening health science and innovation. Finally, there is no doubt that more randomized studies with strict bias control are needed to clarify the safety and efficacy profiles of tirofiban. However, it is not prudent to conclude and try to support the safety of this compound in a series of cases with a reduced sample considering that there is better quality evidence proving the contrary. Funding This study did not receive any funding or financial support. Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.