Efficacy and safety of intravenous tirofiban combined with reperfusion therapy versus reperfusion therapy alone in acute ischemic stroke: a meta-analysis of randomized controlled trials.

Abstract

Several studies have shown an additional benefit of tirofiban administration in patients with acute ischemic stroke (AIS) who underwent reperfusion therapy. According to the last revised guidelines, the efficacy of tirofiban in treating AIS is not well-established. Therefore, we performed a meta-analysis to assess the efficacy and safety of reperfusion therapy with tirofiban compared to reperfusion therapy alone in treating AIS. We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) reporting the use of tirofiban combined with reperfusion therapy in AIS patients within 72 h after the onset of symptoms with 90 days minimum follow-up. We employed risk ratio (RR) and Mean Differences (MD) with 95% confidence intervals (CIs) as the measure of effect size using a random-effects model. We included seven RCTs comprising 1607 patients, of whom 815 (50.7%) received tirofiban combined with reperfusion therapy and 792 (49.3%) received reperfusion therapy alone (no-tirofiban). The addition of tirofiban to the reperfusion therapy resulted in a higher rate of favorable outcomes (RR 1.25; 95% CI 1.11-1.40; p < 0.001) with less functional disability (RR 0.72; 95% CI 0.53-0.98; p < 0.05). The administration of tirofiban significantly improved the National Institutes of Health Stroke Scale (NIHSS) after seven days (MD - 2.27; 95% CI - 4.32 to - 0.22; p = 0.03). A similar rate of successful revascularization was observed between groups (RR 1.18; 95% CI 0.97-1.45; p = 0.09). Tirofiban did not increase the risk of symptomatic intracranial hemorrhage (sICH) (RR 1.47; 95% CI 0.98-2.19; p = 0.06), but increase the risk of any intracranial hemorrhage (ICH), particularly in the endovascular thrombectomy (EVT) subgroup analysis (RR 1.25; 95% CI 1.03-1.51; p = 0.02). Mortality rates were similar between groups RR 1.05; 95% CI 0.80-1.38; p = 0.72). The addition of tirofiban to reperfusion therapy was associated with improved functional outcomes, without a significant increase in ICH. NIHSS after seven days of stroke onset was significantly improved by tirofiban. There was an increase in any ICH events, particularly in EVT patients. Mortality was not significantly altered by tirofiban.