Tang Lisha, Tang Xiangqi, Yang Qianwen
Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China.
Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China,
Cerebrovasc Dis. 2021;50(2):121-131. doi: 10.1159/000512601. Epub 2021 Jan 5.
The purpose of this meta-analysis is to evaluate the safety and efficacy of tirofiban during endovascular treatment (EVT) for acute ischemic stroke (AIS) patients.
We systematically searched PubMed, Embase, Web of Science, and CENTRAL (Cochrane Central Register of Controlled Trials) databases for randomized controlled trials and cohort studies (published before May 1, 2020; no language restrictions) comparing tirofiban administration to blank control during EVT in patients with AIS. Our primary end points were the 3-month functional outcome, recanalization rate, symptomatic intracerebral hemorrhage, and 3-month mortality.
The incidence of 3-month modified Rankin Scale (mRS) 0-2 score of the tirofiban group was higher than that of the control group (odds ratio [OR] = 1.27, 95% CI [1.09, 1.48], p = 0.002) with heterogeneity (I2 = 34%, p = 0.11). Data pooled from the 6 studies describing the details of retriever stent in EVT revealed that tirofiban was associated with higher incidence of 3-month mRS 0-2 score (OR = 1.48, 95% CI [1.11, 1.96], p = 0.007). The recanalization rate was higher in the tirofiban group compared to the control group (OR = 1.66, 95% CI [1.16, 2.39], p = 0.006). There were no statistically significant differences in the incidence of symptomatic intracranial hemorrhage (OR = 0.97, 95% CI [0.73, 1.31], p = 0.86) and intracranial hemorrhage (OR = 1.08, 95% CI [0.59, 1.97], p = 0.80) between tirofiban and non-tirofiban group. Besides, the tirofiban administration was associated with lower mortality (OR = 0.75, 95% CI [0.62, 0.91], p = 0.003).
The application of tirofiban in EVT of AIS may improve functional outcomes and reduce mortality at 3 months. Besides, tirofiban does not seem to increase the risk of symptomatic intracranial hemorrhage and intracranial hemorrhage, either in the anterior or posterior circulation stroke.
本荟萃分析旨在评估替罗非班在急性缺血性卒中（AIS）患者血管内治疗（EVT）期间的安全性和有效性。
我们系统检索了PubMed、Embase、Web of Science和CENTRAL（Cochrane对照试验中央注册库）数据库，以查找比较AIS患者在EVT期间使用替罗非班与空白对照的随机对照试验和队列研究（发表于2020年5月1日前；无语言限制）。我们的主要终点是3个月时的功能结局、再通率、症状性颅内出血和3个月死亡率。
替罗非班组3个月改良Rankin量表（mRS）评分为0 - 2分的发生率高于对照组（优势比[OR]=1.27，95%可信区间[CI][1.09，1.48]，p = 0.002），存在异质性（I² = 34%，p = 0.11）。从6项描述EVT中取栓支架细节的研究汇总的数据显示，替罗非班与3个月mRS评分为0 - 2分的较高发生率相关（OR = 1.48，95% CI[1.11，1.96]，p = 0.007）。替罗非班组的再通率高于对照组（OR = 1.66，95% CI[1.16，2.39]，p = 0.006）。替罗非班组与非替罗非班组在症状性颅内出血发生率（OR = 0.97，95% CI[0.73，1.31]，p = 0.86）和颅内出血发生率（OR = 1.08，95% CI[0.59，1.97]，p = 0.80）方面无统计学显著差异。此外，使用替罗非班与较低死亡率相关（OR = 0.75，95% CI[0.62，0.91]，p = 0.003）。
替罗非班在AIS的EVT中的应用可能改善功能结局并降低3个月时的死亡率。此外，替罗非班似乎不会增加症状性颅内出血和颅内出血的风险，无论是在前循环还是后循环卒中中。
