To the Editor: We read with special interest the article written by Limaye et al1 on the role of tirofiban for periprocedural safety in the endovascular intervention for aneurysm treatment. The authors suggest that tirofiban can be used during endovascular procedures in cases in which external ventricular drainage (EVD) or ventriculoperitoneal shunt (VPS) placement is needed, demonstrating a reasonable safety of use. They present their institution's protocol regarding the use of tirofiban in endovascular procedures, requiring an additional EVD/VPS placement. The use of endovenous glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors has been extensively studied in cardiovascular interventionism and is in routine use in this area. In the cerebral vascular aneurysm management, tirofiban has emerged as a potent antiaggregant in the prevention of thrombotic complications.2 The authors describe an interesting protocol, which should be widely studied for its potential usefulness. There are, however, certain steps along with their results and discussion, which we found to be worthy of further discussion. It is important to remark that all but 1 patient included in the study were not on tirofiban by the time the EVD was placed. On top of it, 1 patient who did not require EVD or VPS (this subject had borderline hydrocephalus on presentation) was also included in the analysis. This means that only in 7 cases, a VPS or an EVD was placed while the patient was on tirofiban. A total of 2 out of these 7 cases still developed track hemorrhages. We are assuming track hemorrhages occurred in the setting in which tirofiban was infused before the EVD/VPS was placed, according to the author's statement. This additional analysis would tell us that the procedure-related hemorrhage rate was 28.5%. This is an excellent study from where we could make a couple of important observations: tirofiban is not a zero-risk drug. The appearance of severe thrombocytopenia episodes warrants further studies to identify patients with an increased risk of thrombocytopenia. Likewise, for procedures in which EVD/VPS deployment is planned, it would be recommendable to wait for 4 half-lives instead of just 2, in order to reduce as much as possible the drug effect, as only 6.25% of the drug shall remain in the blood.3 In clinical trials using tirofiban,3 the incidence of severe thrombocytopenia (platelets less than 50 × 109/L) ranged from 0.1% to 0.5%. This is approximately 2-fold the incidence seen in patients in whom tirofiban was not administered. Finally, we would like to mention that the potential protective effects of tirofiban have been demonstrated along experimental studies.4 We strongly believe this area requires further study in the clinical scenario. In an open pilot study of 35 patients with progressive stroke,4 the combination of intravenous tirofiban with aspirin 100 mg was associated with a significant reversal of stroke progression in patients with small-vessel occlusions. GP IIa/IIIb inhibition might interfere with stroke progression and lipohyalinosis, intracranial branch atherothrombosis, and endothelial dysfunction, and, thus, may result in improved microcirculation.4 If this is the case, then this drug might be useful for stroke cases and for patients requiring long-term anticoagulation. Once again, we congratulate the authors for an excellent study protocol and enviable results, hoping that the phase-2 study mentioned in the article would further shed light on this difficult scenario. Disclosures The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.