Efficacy and Safety of Intravenous Tirofiban in the Management of Patients with Acute Ischemic Stroke Due to Large Artery Atherosclerosis That Had Undergone Endovascular Thrombectomy: A Systematic Review and Meta-Analysis
Ocílio Ribeiro Gonçalves1, Saul Dominici2, Christian Ken Fukunaga3, Naysha Myllene de Lima Gonçalves4, Rebeca Silva5, Frederico De Sousa Marinho Mendes Filho6, Filipe Virgilio Ribeiro7, Kenzo Ogasawara8, Kelson Almeida1
1Federal University of Piauí, 2Federal University of Maranhão, 3Faculty of Medicine, FMABC University Center, 4Facid Wyden University Center, 5Federal University of Paraíba, 6Federal University of Amazonas, 7Barão de Mauá University Center, Faculty of Medicine, 8Bahiana School of Medicine and Public Health
Objective:
To assess the safety and efficacy of intravenous tirofiban in AIS patients due to LAA submitted to endovascular treatment.
Background:
Tirofiban is shown to be effective in acute ischemic stroke (AIS) patients submitted to mechanical thrombectomy. However, there is a lack of evidence on the effects of intravenous tirofiban on endovascular therapy in patients with large artery atherosclerosis (LAA).
Design/Methods:
Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases were systematically searched for studies that involved tirofiban in AIS caused by LAA. The statistical analysis was performed using Risk Ratio (RR) with 95% confidence intervals and the Mantel-Haenszel method of random‐effects model to evaluate both efficacy and safety. Heterogeneity was assessed using I² statistics and Cochran Q test. This meta-analysis evaluated a modified Rankin scale (mRS) between 0 and 2, Successful reperfusion, serious intracranial hemorrhage (sICH), and mortality in 90 days. The statistical analyses for this study were performed using R software (version 4.4.1.).
Results:
A total of 7 studies were analyzed, a total of 2.438 patients were included. In the meta-analysis, the tirofiban group was associated with a higher proportion of patients in mRS 0-2 (RR 1.15; 95% CI 1.03-1.29; I² = 0%), it was not different from the No Intravenous tirofiban (IT) group regarding successful reperfusion (RR 1.04; 95% CI 0.97-1.11; I² = 70%), as well as it was not different for sICH (RR 0.81; 95% CI 0.51-1.28; I² = 32%), although it was associated with a lower mortality in 90 days rate (RR 0.69; 95% CI 0.59-0.81; I² = 0%).
Conclusions:
This meta-analysis underscores the effects of tirofiban. It has been shown to improve functionality and lower mortality rates in this population and to be a reliable medication in this setting.
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