Department of Neurology, Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, China.
Third Clinical Medical College, Shanxi Medical University, Taiyuan, China.
Cerebrovasc Dis. 2023;52(5):587-596. doi: 10.1159/000527861. Epub 2022 Dec 29.
Tirofiban has been used as a rescue when thrombectomy is not successful in endovascular therapy (EVT) for acute ischemic stroke (AIS), but the use of tirofiban after intravenous thrombolysis (IVT) is controversial. The purpose of this meta-analysis was to evaluate the safety and efficacy of tirofiban combined with IVT in AIS compared with not receiving tirofiban.
The PubMed and Embase databases were searched for all relevant studies published up to August 31, 2021. The safety endpoints included symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and mortality. The efficacy endpoint was the modified Rankin Scale (mRS) score at the 3-month follow-up.
Seven articles (1,036 patients) were included. Of these, 444 patients received tirofiban, and 592 patients did not. Meta-analysis showed that tirofiban did not increase the risk of sICH (OR 0.98; 95% CI 0.50-1.93; p = 0.96), any ICH (OR 0.94; 95% CI 0.63-1.39; p = 0.75) or mortality (OR 0.67; 95% CI 0.39-1.15; p = 0.15) and tended to be associated with a favorable functional outcome (OR 1.33; 95% CI 0.99-1.78; p = 0.06) in patients with AIS. Subgroup analysis showed that bridging therapy combined with tirofiban could reduce mortality (OR 0.47; 95% CI 0.23-0.98; p = 0.04). Tirofiban significantly improved the favorable functional outcome in patients with IVT only (non-EVT) (OR 1.98; 95% CI 1.30-3.02; p = 0.002).
Intravenous tirofiban could be safe for patients with AIS undergoing IVT, regardless of receiving EVT. Intravenous tirofiban may reduce mortality rates for patients undergoing bridging therapy. It also could increase the likelihood of a favorable functional outcome, especially for patients receiving IVT only.
替罗非班已被用作急性缺血性脑卒中（AIS）血管内治疗（EVT）失败时的抢救药物，但在静脉溶栓（IVT）后使用替罗非班存在争议。本荟萃分析的目的是评估与未接受替罗非班相比，替罗非班联合 IVT 在 AIS 中的安全性和疗效。
检索截至 2021 年 8 月 31 日发表的所有相关研究，检索 PubMed 和 Embase 数据库。安全性终点包括症状性颅内出血（sICH）、任何颅内出血（ICH）和死亡率。疗效终点是 3 个月随访时的改良 Rankin 量表（mRS）评分。
纳入 7 篇文献（1036 例患者），其中 444 例患者接受替罗非班治疗，592 例患者未接受。Meta 分析显示，替罗非班并未增加 sICH 的风险（OR 0.98；95%CI 0.50-1.93；p=0.96）、任何 ICH 的风险（OR 0.94；95%CI 0.63-1.39；p=0.75）或死亡率（OR 0.67；95%CI 0.39-1.15；p=0.15），并且倾向于与 AIS 患者的良好功能结局相关（OR 1.33；95%CI 0.99-1.78；p=0.06）。亚组分析显示，桥接治疗联合替罗非班可降低死亡率（OR 0.47；95%CI 0.23-0.98；p=0.04）。替罗非班显著改善了仅接受 IVT（非 EVT）的患者的良好功能结局（OR 1.98；95%CI 1.30-3.02；p=0.002）。
替罗非班静脉内应用于接受 IVT 的 AIS 患者是安全的，无论是否接受 EVT。替罗非班可能降低桥接治疗患者的死亡率。它还可能增加良好功能结局的可能性，特别是对仅接受 IVT 的患者。
