急性缺血性脑卒中患者服用替罗非班加重组组织浆细胞酶原激活剂与单用重组组织浆细胞酶原激活剂的疗效和安全性：一项荟萃分析。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-11-03 DOI:10.1016/j.jstrokecerebrovasdis.2024.108111

Yonghong Yang MB , Qingwu Yang MD

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引用次数: 0

摘要

目的：替罗非班加重组组织浆细胞酶原激活剂（rtPA）治疗急性缺血性卒中（AIS）患者显示出良好的疗效和安全性，但缺乏全面的评估。本荟萃分析旨在比较 rtPA 加替罗非班与单用 rtPA 对 AIS 患者的疗效和安全性：本荟萃分析检索了截至2024年3月在Excer Medica数据库、Web of Science、Cochrane、PubMed、中国国家知识基础设施、万方和SinoMed中对AIS患者进行rtPA静脉溶栓后加替罗非班（rtPA+T组）与单纯rtPA静脉溶栓（rtPA组）比较的研究：本次荟萃分析共纳入20项研究，2048名AIS患者。治疗后美国国立卫生研究院卒中量表（NIHSS）评分在rtPA+T组低于rtPA组[标准化平均差（SMD）=-1.41；95%置信区间（CI）=-1.83，-0.98；P0.05]。结论：在AIS患者中，rtPA+替罗非班与单用rtPA相比，疗效更优，安全性相当。

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Efficacy and safety of tirofiban plus recombinant tissue plasminogen activator versus recombinant tissue plasminogen activator alone in acute ischemic stroke patients: a meta-analysis

Objective

Tirofiban plus recombinant tissue plasminogen activator (rtPA) shows good efficacy and safety in treating acute ischemic stroke (AIS) patients, but there is a lack of comprehensive assessment. This meta-analysis aimed to compare the efficacy and safety of rtPA plus tirofiban with rtPA alone in AIS patients.

Methods

This meta-analysis retrieved studies comparing rtPA intravenous thrombolysis followed by tirofiban (rtPA+T group) versus rtPA intravenous thrombolysis alone (rtPA group) for AIS patients in Excerpt Medica Database, Web of Science, Cochrane, PubMed, China National Knowledge Infrastructure, Wanfang, and SinoMed until March 2024.

Results

Twenty studies with 2048 AIS patients were enrolled in this meta-analysis. National Institute of Health stroke scale (NIHSS) score after treatment was lower in the rtPA+T group than the rtPA group [standardized mean differences (SMD)=-1.41; 95 % confidence interval (CI)=-1.83, -0.98; P<0.001]. The proportion of AIS patients achieving a favorable functional outcome (modified Rankin Scale score ≤2) was increased in the rtPA+T group versus the rtPA group [relative risk (RR)=1.13; 95 % CI=1.05, 1.21; P=0.001]. The incidence of re-occlusion was lower in the rtPA+T group than in the rtPA group (RR=0.24; 95 % CI=0.10, 0.59; P=0.002), but the incidence of intracranial hemorrhage (ICH) (RR=0.85; 95 % CI=0.51, 1.43), symptomatic ICH (RR=1.10; 95 % CI=0.43, 2.84), and mortality (RR=1.39; 95 % CI=0.53, 3.65) was not different between the two groups (all P>0.05). The stability assessed by sensitivity analysis was good, and no publication bias was found.

Conclusion

rtPA plus tirofiban achieves superior efficacy with comparable safety profiles compared to rtPA alone in AIS patients.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.