Eptifibatide as an adjuvant therapy to thrombolysis versus thrombolysis alone in stroke management: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Stroke is a leading cause of death and disability. Thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the primary treatment for acute ischemic stroke (AIS), but outcomes remain suboptimal. Eptifibatide, a glycoprotein IIb/IIIa inhibitor, has been explored as an adjunct to enhance reperfusion. This systematic review and meta-analysis assesses its effectiveness and safety compared to rt-PA alone. We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs). Primary outcomes included 90-day functional independence (modified Rankin Scale, mRS 0-1), mortality, and symptomatic intracranial hemorrhage (sICH). Meta-analyses used random-effects models to calculate Odds Ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed with I². We included 988 patients from four RCTs. Eptifibatide was administered to 566 patients (57.3%). Adjuvant therapy did not significantly improved mRS 0-1 rates at 90 days (OR 1.12, 95% CI 0.60-2.09, p = 0.72, I²=74%) and did not reduce mortality (OR 1.55, 95% CI 0.92-2.61, p = 0.099, I²=0%). sICH was not statistically significantly different between the groups (OR 0.38, 95% CI 0.09-1.65, p = 0.196, I²=56%). Eptifibatide as an adjunct to rt-PA does not significantly impact functional independence, mortality, or sICH risk in AIS. Larger studies are needed to clarify its potential benefits and risks.