Department of Neurosurgery, First Hospital of Shanxi Medical University, Taiyuan, People's Republic of China.
Both the authors contributed equally to this work.
Clin Appl Thromb Hemost. 2020 Jan-Dec;26:1076029620942594. doi: 10.1177/1076029620942594.
Endovascular therapy and intravenous thrombolysis with recombinant tissue plasminogen activator are the 2 most recommended treatments for acute ischemic stroke (AIS). Glycoprotein (GP) IIb-IIIa inhibitors are short-acting selective reversible antiplatelet agents that emerged as promising therapeutic agents for AIS about 10 years ago. Given the unclear safety profile and application coverage of GP inhibitors, we conducted this meta-analysis to explore the same.
We used , , and as the key words on Medline, Web of Science, and the Embase databases. Randomized controlled trials, prospective literatures, and retrospective studies in English published between 1990 and 2020 were screened. The outcomes were relative risk (RR) of death and 90-day intracerebral hemorrhage (ICH). We pooled the results in 2 categories and conducted a subgroup analysis stratified by different drugs. The choice of the effects model depended on the value of .
In all, 3700 patients from 20 studies were included. No GP IIb-IIIa inhibitors were found to have a remarkable influence on the ICH rate. The RR values of symptomatic ICH for abciximab and eptifibatide were 4.26 (1.89, 9.59) and 0.17 (0.04, 0.69), respectively. Both tirofiban and abciximab could decrease the mortality rate within 90 days. Age > 70 years, National Institutes of Health Stroke Scale > 15, and overall dose > 10 mg are risk factors for ICH events with tirofiban usage. Thrombectomy combined with tirofiban was safe for arterial reocclusion prevention.
In stroke-related treatment, administration of GP IIb-IIIa inhibitors could be safe, but care should be taken regarding drug species and doses. Abciximab can increase the risk of symptomatic intracranial hemorrhage. Tirofiban and eptifibatide can be considered safe in low doses. Suitable patients should be selected using strict criteria.
血管内治疗和重组组织纤溶酶原激活物静脉溶栓是治疗急性缺血性脑卒中（AIS）的两种最推荐的治疗方法。糖蛋白（GP）IIb-IIIa 抑制剂是一种新型的短作用、选择性、可逆的抗血小板药物，大约 10 年前成为 AIS 治疗的有前途的治疗药物。鉴于 GP 抑制剂的安全性和应用范围尚不清楚，我们进行了这项荟萃分析以探讨其安全性和应用范围。
我们使用 Medline、Web of Science 和 Embase 数据库中的 、 和 作为关键词进行检索。筛选了 1990 年至 2020 年期间发表的英文随机对照试验、前瞻性文献和回顾性研究。结局指标为死亡率和 90 天内颅内出血（ICH）的相对风险（RR）。我们将结果分为 2 类，并按不同药物进行亚组分析。效应模型的选择取决于 值。
共纳入 20 项研究的 3700 名患者。没有发现 GP IIb-IIIa 抑制剂对 ICH 发生率有显著影响。阿昔单抗和依替巴肽的症状性 ICH 的 RR 值分别为 4.26（1.89，9.59）和 0.17（0.04，0.69）。替罗非班和阿昔单抗均能降低 90 天内的死亡率。年龄>70 岁、NIHSS>15 分、总剂量>10mg 是替罗非班治疗时发生 ICH 的危险因素。血栓切除术联合替罗非班预防动脉再闭塞是安全的。
在与卒中相关的治疗中，使用 GP IIb-IIIa 抑制剂可能是安全的，但应注意药物种类和剂量。阿昔单抗可增加症状性颅内出血的风险。小剂量的替罗非班和依替巴肽是安全的。应使用严格的标准选择合适的患者。
