Safety and Efficacy of Tirofiban in Acute Ischemic Stroke Patients Receiving Endovascular Treatment: A Meta-Analysis.

Objectives: Tirofiban is widely used in clinical practice for acute ischemic stroke (AIS). However, whether tirofiban increases the bleeding risk or improves the outcome of AIS patients with endovascular treatment (ET) is unknown. The aim of this meta-analysis is to evaluate the safety and efficacy of tirofiban compared with those without tirofiban in AIS patients receiving ET.

Methods: Systematic literature search was done in PubMed and EMBASE databases without language or time limitation. Safety outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. Efficacy outcomes were recanalization rate and favorable functional outcome. Review Manager 5.3 and Stata Software Package 15.0 were used to perform the meta-analysis.

Results: Eleven studies with a total of 2,028 patients were included. A total of 704 (34.7%) patients were administrated tirofiban combined with ET. Meta-analysis suggested that tirofiban did not increase the risk of sICH (odds ratio (OR) 1.08; 95% confidence interval (CI) 0.81-1.46; p = 0.59) but significantly decreased mortality (OR 0.68; 95% CI 0.52-0.89; p = 0.005). There was no association between tirofiban and recanalization rate (OR 1.26; 95% CI 0.86-1.82; p = 0.23) or favorable functional outcome (OR 1.21; 95% CI 0.88-1.68; p = 0.24). Subgroup analyses indicated that preoperative tirofiban significantly increase recanalization rate (OR 3.89; 95% CI 1.70-8.93; p = 0.001) and improve favorable functional outcome (OR 2.30; 95% CI 1.15-4.60; p = 0.02).

Conclusions: Tirofiban is safe in AIS patients with ET and can significantly reduce mortality; preoperative tirofiban may be effective, but further studies are needed to confirm the efficacy.