Efficacy and safety of intravenous tirofiban versus standard medical treatment in acute ischemic stroke: A meta-analysis of randomized controlled trials

Abstract

Introduction

Tirofiban is a fast-acting glycoprotein IIb-IIIa inhibitor that inhibits the final common pathway to platelet aggregation and has been studied as adjuvant therapy for acute ischemic stroke (AIS). Since the prior meta-analysis new randomized controlled trials (RCTs) have been published. This meta-analysis aimed to update the current knowledge on the efficacy of tirofiban for patients with AIS not submitted to reperfusion therapies.

Methods

We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for RCTs reporting the use of tirofiban in AIS. The efficacy outcomes were favorable functional outcome, functional disability, modified Rankin Scale change at 90 days, and changes in the National Institutes of Health Stroke Scale score after 24 hours and 7 days of the symptom onset. The safety outcomes include symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and all-cause mortality.

Results

A higher rate of favorable functional outcome was associated with tirofiban administration (RR= 1.09; 95 % CI 1.04–1.14; p<0.001). The mRS after 90 days was significantly lower in the tirofiban group (MD= −0.55; 95 % CI −0.90 – [-0.20]; p<0.01). Tirofiban administration was not significantly associated with higher rates of sICH in AIS patients (RR= 0.85; 95 % CI 0.26–2.81; p = 0.79) or any ICH compared to the control group (RR= 1.01; 95 % CI 0.42–2.39; p = 0.98). All-cause mortality was similar between groups (RR= 0.64; 95 % CI 0.34–1.23; p = 0.18).

Conclusion

Tirofiban increases the number of patients achieving a favorable functional outcome in patients. There was no improvement in NIHSS after 24 hours and 7 days. Tirofiban did not increase the risk of sICH or any ICH, and mortality was similar between groups.