Gabriel de Almeida Monteiro , Antonio Mutarelli , Marianna Leite , Gabriel Marinheiro , Beatriz Araujo , Ocílio Ribeiro Gonçalves , Joaquim Francisco Cavalcante-Neto , Paulo Roberto Lacerda Leal , Keven Ferreira da Ponte , Eberval Gadelha Figueiredo , João Paulo Mota Telles
{"title":"急性缺血性脑卒中静脉注射替罗非班与标准药物治疗的疗效和安全性对比:随机对照试验荟萃分析","authors":"Gabriel de Almeida Monteiro , Antonio Mutarelli , Marianna Leite , Gabriel Marinheiro , Beatriz Araujo , Ocílio Ribeiro Gonçalves , Joaquim Francisco Cavalcante-Neto , Paulo Roberto Lacerda Leal , Keven Ferreira da Ponte , Eberval Gadelha Figueiredo , João Paulo Mota Telles","doi":"10.1016/j.clineuro.2024.108602","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>We systematically searched <em>PubMed</em>, <em>Embase</em>, and <em>Cochrane Central Register of Controlled Trials</em> 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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"247 ","pages":"Article 108602"},"PeriodicalIF":1.8000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Efficacy and safety of intravenous tirofiban versus standard medical treatment in acute ischemic stroke: A meta-analysis of randomized controlled trials\",\"authors\":\"Gabriel de Almeida Monteiro , Antonio Mutarelli , Marianna Leite , Gabriel Marinheiro , Beatriz Araujo , Ocílio Ribeiro Gonçalves , Joaquim Francisco Cavalcante-Neto , Paulo Roberto Lacerda Leal , Keven Ferreira da Ponte , Eberval Gadelha Figueiredo , João Paulo Mota Telles\",\"doi\":\"10.1016/j.clineuro.2024.108602\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>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.</div></div><div><h3>Methods</h3><div>We systematically searched <em>PubMed</em>, <em>Embase</em>, and <em>Cochrane Central Register of Controlled Trials</em> 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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":10385,\"journal\":{\"name\":\"Clinical Neurology and Neurosurgery\",\"volume\":\"247 \",\"pages\":\"Article 108602\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-10-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Neurology and Neurosurgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S030384672400489X\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Neurology and Neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S030384672400489X","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
简介:替罗非班是一种快速起效的糖蛋白 IIb-IIIa 抑制剂,可抑制血小板聚集的最终共同途径,已被研究作为急性缺血性中风(AIS)的辅助疗法。自上次荟萃分析以来,又有新的随机对照试验(RCT)发表。本荟萃分析旨在更新关于替罗非班对未接受再灌注治疗的 AIS 患者疗效的现有知识。方法我们系统检索了 PubMed、Embase 和 Cochrane Central Register of Controlled Trials 中报告替罗非班用于 AIS 的 RCT。疗效结果包括良好的功能预后、功能障碍、90天时改良Rankin量表的变化以及症状发作24小时后和7天后美国国立卫生研究院卒中量表评分的变化。安全性结果包括症状性颅内出血(sICH)、任何颅内出血(ICH)和全因死亡率。结果 使用替罗非班可提高功能良好率(RR= 1.09;95 % CI 1.04-1.14;p<0.001)。替罗非班组 90 天后的 mRS 显著降低(MD= -0.55;95 % CI -0.90 - [-0.20];p<0.01)。与对照组(RR= 1.01;95 % CI 0.42-2.39;p = 0.98)相比,服用替罗非班与 AIS 患者 sICH 发生率升高(RR= 0.85;95 % CI 0.26-2.81;p = 0.79)或任何 ICH 发生率升高无明显相关性。各组的全因死亡率相似(RR= 0.64; 95 % CI 0.34-1.23; p = 0.18)。24小时和7天后NIHSS没有改善。替罗非班不会增加 sICH 或任何 ICH 的风险,各组死亡率相似。
Efficacy and safety of intravenous tirofiban versus standard medical treatment in acute ischemic stroke: A meta-analysis of randomized controlled trials
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.
期刊介绍:
Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.