Department of Neurology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China.
Eur Rev Med Pharmacol Sci. 2020 Feb;24(3):1492-1503. doi: 10.26355/eurrev_202002_20208.
The purpose of this systematic review and meta-analysis was to analyze the safety and efficacy of tirofiban when used for acute ischemic stroke (AIS) patients not undergoing endovascular treatment.
An electronic search was performed for English-language studies on PubMed, Scopus, Embase, and CENTRAL (Cochrane Central Register of Controlled Trials) databases up to 31st July 2019. All types of studies comparing tirofiban monotherapy or combined intravenous (IV) thrombolysis and tirofiban therapy with controls for AIS patients were included.
Six studies were included in the review. Three evaluated tirofiban monotherapy while three compared IV thrombolysis and tirofiban therapy with controls. Meta-analysis indicates that tirofiban monotherapy does not significantly increase the incidence of intracerebral hemorrhage (ICH) (Odds Ration [OR] 1.14, 95% CI 0.72-1.82, p = 0.57; I2 = 0%), symptomatic intracerebral hemorrhage (sICH) (OR 0.52, 95% CI 0.09-3.03, p = 0.46; I2 = 0%) and mortality (OR 0.53, 95% CI 0.13-2.07, p = 0.36; I2 = 63%) in AIS patients. Similarly, our analysis indicates no significant increase in the rates of ICH (OR 0.82, 95% CI 0.33-2.07, p = 0.68; I2 = 0%), sICH (OR 0.91, 95% CI 0.16-5.16, p = 0.91; I2 = 0%) and mortality (OR 1.50, 95% CI 0.42-5.38, p= 0.54; I2 = 0%) in AIS patients treated with combined IV thrombolysis and tirofiban therapy. Meta-analysis for functional outcome was not possible.
To conclude, tirofiban appears to be safe when used following IV thrombolysis or as monotherapy in AIS patients. Conclusions regarding improvement in functional improvement cannot be drawn. Further trials are needed to strengthen the evidence on this topic.
本系统评价和荟萃分析的目的是分析替罗非班用于未接受血管内治疗的急性缺血性脑卒中（AIS）患者的安全性和疗效。
对 PubMed、Scopus、Embase 和 Cochrane 中央对照试验注册库（CENTRAL）数据库中的英文研究进行电子检索，检索时间截至 2019 年 7 月 31 日。所有类型的研究均纳入比较替罗非班单药治疗或联合静脉（IV）溶栓和替罗非班治疗与对照组用于 AIS 患者的研究。
本研究纳入了 6 项研究。其中 3 项评估了替罗非班单药治疗，3 项比较了 IV 溶栓和替罗非班治疗与对照组。荟萃分析表明，替罗非班单药治疗并未显著增加颅内出血（ICH）的发生率（优势比 [OR] 1.14，95%CI 0.72-1.82，p = 0.57；I² = 0%）、症状性颅内出血（sICH）（OR 0.52，95%CI 0.09-3.03，p = 0.46；I² = 0%）和死亡率（OR 0.53，95%CI 0.13-2.07，p = 0.36；I² = 63%）。同样，我们的分析表明，替罗非班联合 IV 溶栓治疗并未显著增加 ICH（OR 0.82，95%CI 0.33-2.07，p = 0.68；I² = 0%）、sICH（OR 0.91，95%CI 0.16-5.16，p = 0.91；I² = 0%）和死亡率（OR 1.50，95%CI 0.42-5.38，p = 0.54；I² = 0%）。替罗非班治疗急性缺血性脑卒中患者的功能结局的荟萃分析无法进行。
总之，替罗非班在急性缺血性脑卒中患者接受 IV 溶栓或单药治疗后似乎是安全的。关于功能改善的结论不能得出。需要进一步的试验来加强这一主题的证据。
