Effects of Tirofiban on Functional Outcomes in Patients with Acute Ischemic Stroke Ineligible for Reperfusion Therapy: A Systematic Review and Meta-Analysis of Randomized Studies
Yuri de Souza1, Giovanni Berton2, Gabriela Carolino3, Heloisa Omuro1, Sophia Toscano1, Marianna Leite4, Abner Lucas De Souza5, Evelyn de Pacheco1
1Faculdade de Medicina do ABC (FMABC), 2Universidade de Passo Fundo (UPF), 3Faculdade de Ciências Médicas e da Saúde de Juiz de Fora - Suprema, 4Faculdade Santa Marcelina (FASM), 5Universidade Evangélica de Goiás
Objective:
We conducted a systematic review and meta-analysis to compare intravenous tirofiban versus standard treatment (supportive treatment, acetylsalicylic acid and/or clopidogrel) in acute ischemic stroke patients ineligible for reperfusion therapy.
Background:
In patients ineligible for reperfusion therapy with intravenous thrombolysis or mechanical thrombectomy, therapeutic options are limited to aspirin and clopidogrel. Tirofiban is a GP-IIb/IIIa inhibitor that could improve functional outcomes in these patients.
Design/Methods:
We searched PubMed, Embase, and Cochrane from inception to August 2024. The inclusion criteria consisted of randomized studies that compared tirofiban versus standard treatment. Outcomes of interest were 90-day modified Rankin Scale (mRS) 0-1, National Institutes of Health Stroke Scale (NIHSS) score at 7 days, and 90-day all-cause mortality. A random-effects model was used to calculate the risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). Statistical analysis was performed with R programming language 4.3. The review protocol was registered at PROSPERO (CRD42024587513).
Results:
We screened 2,182 articles and fully reviewed 14 of them. A total of eight studies, comprising 2,673 patients were included. The use of tirofiban had a higher rate of 90-day mRS 0-1 when compared to standard treatment (RR 1.18; CI 1.03 to 1.37; p = 0.1; I² = 44 %). However, we found no difference between groups in NIHSS at 7 days (MD -1.87; CI -5.89 to 2.15; p < 0.01; I² = 82 %) and 90-day all-cause mortality (RR 1.00; CI 0.41 to 2.45; p < 0.29; I² = 20 %).
Conclusions:
Tirofiban was associated with better long-term functional outcomes than standard treatment. However, there was no benefit regarding short-term neurologic status or mortality.
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