Department of Neurology, The Frist Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
Department of Neurology, Hechuan District People's Hospital, Chongqing 401500，China.
Clin Neurol Neurosurg. 2023 May;228:107702. doi: 10.1016/j.clineuro.2023.107702. Epub 2023 Mar 28.
Mechanical thrombectomy is now widely used in acute ischaemic stroke, but its adjunctive antiplatelet aggregation regimen is controversial. This study aimed to investigate the safety and efficacy of tirofiban in patients with acute ischaemic stroke (AIS) who underwent mechanical thrombectomy.
We systematically searched Pubmed, Embase, Cochrane Library, and Web of science. Randomized controlled studies and cohort studies comparing the tirofiban group and non-tirofiban group (control group) in patients with AIS who underwent mechanical thrombectomy. The primary safety outcomes were symptomatic intracranial hemorrhage (sICH), 3-month mortality, and re-occlusion rate. The primary efficacy outcomes were good functional outcome (mRS 0-2), excellent functional outcome (mRS 0-1), and successful recanalization (mTICI≥2b).
We included 22 studies with a total of 6062 patients. For safety outcomes, the tirofiban group had a non-significantly higher rate of sICH (OR = 0.90, 95 % CI = 0.73-1.10, P = 0.29) and a significantly lower rate of re-occlusion (OR = 0.40, 95 % CI = 0.19-0.82, P = 0.01) and 3-month mortality (OR = 0.71, 95 % CI = 0.61-0.82, P < 0.00001) compared to the control group. In terms of efficacy outcomes, significant improvement in good functional outcomes (mRS 0-2) (OR = 1.24, 95 % CI = 1.11-1.39, P = 0.0002) and recanalization rate (OR = 1.38, 95% CI = 1.17-1.62, P = 0.0001) compared to tirofiban, but not significant improvement in excellent functional outcomes(OR = 1.14, 95 % CI = 0.93-1.39, P = 0.21). In addition, compared with cardiogenic stroke, the large atherosclerotic stroke had a higher rate of good functional outcome (OR = 1.58, 95 % CI = 1.18-2.11, P = 0.002) and a lower rate of 3-month mortality (OR = 0.58, 95 % CI = 0.39-0.85, P = 0.005). Subgroup analysis by route of administration showed a significant improvement in good functional outcome in the intravenous group (OR = 1.27, 95 % CI = 1.08-1.50, P = 0.004), while no significant difference was found between the arterial and arteriovenous groups.
Treatment with tirofiban in patients with AIS with mechanical thrombectomy is effective in improving functional prognosis, arterial recanalization rates, and reducing 3-month mortality and re-occlusion rates, particularly in patients with large atherosclerotic stroke, without increasing the rate of symptomatic intracranial hemorrhage. Intravenous administration of tirofiban significantly improves the clinical prognosis compared to arterial administration. Tirofiban is effective and safe in patients with AIS.
机械血栓切除术现在广泛应用于急性缺血性脑卒中，但它的辅助抗血小板聚集方案存在争议。本研究旨在探讨替罗非班在接受机械血栓切除术的急性缺血性脑卒中（AIS）患者中的安全性和疗效。
我们系统地检索了 Pubmed、Embase、Cochrane 图书馆和 Web of science。比较了接受机械血栓切除术的 AIS 患者中替罗非班组和非替罗非班组（对照组）的随机对照研究和队列研究。主要安全性结局是症状性颅内出血（sICH）、3 个月死亡率和再闭塞率。主要疗效结局是良好的功能结局（mRS 0-2）、优秀的功能结局（mRS 0-1）和成功再通（mTICI≥2b）。
我们纳入了 22 项研究，共 6062 例患者。在安全性结局方面，替罗非班组的 sICH 发生率无显著升高（OR = 0.90，95%CI = 0.73-1.10，P = 0.29），但再闭塞率（OR = 0.40，95%CI = 0.19-0.82，P = 0.01）和 3 个月死亡率（OR = 0.71，95%CI = 0.61-0.82，P < 0.00001）显著降低与对照组相比。在疗效结局方面，与替罗非班组相比，替罗非班显著改善了良好的功能结局（mRS 0-2）（OR = 1.24，95%CI = 1.11-1.39，P = 0.0002）和再通率（OR = 1.38，95%CI = 1.17-1.62，P = 0.0001），但优秀的功能结局（OR = 1.14，95%CI = 0.93-1.39，P = 0.21）无显著改善。此外，与心源性脑卒中相比，大动脉硬化性脑卒中具有更高的良好功能结局发生率（OR = 1.58，95%CI = 1.18-2.11，P = 0.002）和更低的 3 个月死亡率（OR = 0.58，95%CI = 0.39-0.85，P = 0.005）。通过给药途径进行的亚组分析显示，静脉组的良好功能结局显著改善（OR = 1.27，95%CI = 1.08-1.50，P = 0.004），而动脉组和动静脉组之间无显著差异。
替罗非班治疗机械血栓切除术治疗 AIS 可有效改善功能预后、动脉再通率，降低 3 个月死亡率和再闭塞率，尤其是在大动脉硬化性脑卒中患者中，不会增加症状性颅内出血的发生率。静脉内给予替罗非班与动脉内给予替罗非班相比，显著改善了临床预后。替罗非班在 AIS 患者中是有效且安全的。
