Department of Neurology, The Frist Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Neurology, Hechuan District People's Hospital, Chongqing, China.
Medicine (Baltimore). 2023 Oct 6;102(40):e35091. doi: 10.1097/MD.0000000000035091.
The use of tirofiban as an adjunct to endovascular therapy (EVT) for acute ischemic stroke has been controversial. We aimed to assess the differences in safety and efficacy of EVT adjuvant to tirofiban in patients with anterior circulation stroke (ACS) and posterior circulation stroke (PCS).
We systematically searched Pubmed, Embase, Cochrane Library, and Web of Science. Cohort studies and randomized controlled trials that compared treatment with tirofiban combined with EVT and EVT alone were included in our meta-analysis. The safety outcomes were symptomatic intracranial hemorrhage, and 3-month mortality. The efficacy outcomes were good functional outcome, excellent functional outcome, and successful recanalization (mTICI ≥ 2b). We performed subgroup analyses of anterior and posterior circulation strokes.
We included 15 studies with 4608 patients. For safety outcomes, tirofiban significantly reduced 3-month mortality in the ACS subgroup (odd ratio [OR] = 0.80, 95% confidence interval [CI] = 0.65-0.98, P = .03) without increasing the rate of symptomatic intracranial hemorrhage (OR = 1.12, 95% CI = 0.88-1.44, P = .35). In the PCS subgroup, tirofiban significantly reduced 3-month mortality (OR = 0.63, 95% CI = 0.50-0.80, P = .0001) and symptomatic intracranial hemorrhage (OR = 0.60, 95% CI = 0.37-0.95, P = .03). For efficacy outcomes, in the ACS subgroup, tirofiban significantly improved good functional outcome (OR = 1.24, 95% CI = 1.06-1.45, P = .008) but did not improve recanalization (OR = 1.17, 95% CI = 0.93-1.47, P = .17) and excellent functional outcome (OR = 1.19, 95% CI = 0.97-1.46, P = .10). In the PCS subgroup, tirofiban significantly improved recanalization rate (OR = 1.94, 95% CI = 1.43-2.65, P < .0001) and did not improve good functional outcome (OR = 1.03, 95% CI = 0.81-1.30, P = .81) and excellent functional outcome (OR = 0.84, 95% CI = 0.58-1.20, P = .34).
In acute ischemic stroke patients undergoing EVT, tirofiban improves good functional outcomes in ACS patients and increases recanalization rates in PCS patients on the 1 hand, reduces mortality, and does not increase the risk of symptomatic intracranial hemorrhage on the other. Tirofiban is safe and effective in both anterior circulation stroke and posterior circulation stroke patients undergoing EVT. More large multicentre randomized controlled studies are needed in the future.
替罗非班作为急性缺血性脑卒中血管内治疗（EVT）的辅助治疗一直存在争议。本研究旨在评估替罗非班联合 EVT 与单纯 EVT 治疗前循环卒中和后循环卒患者的安全性和有效性差异。
我们系统地检索了 Pubmed、Embase、Cochrane 图书馆和 Web of Science。我们的荟萃分析纳入了比较替罗非班联合 EVT 与单纯 EVT 治疗的队列研究和随机对照试验。安全性结局是症状性颅内出血和 3 个月死亡率。有效性结局是良好的功能结局、优秀的功能结局和成功再通（mTICI≥2b）。我们对前循环卒中和后循环卒患者进行了亚组分析。
我们纳入了 15 项研究，共 4608 例患者。对于安全性结局，替罗非班显著降低了前循环卒亚组的 3 个月死亡率（比值比[OR]＝0.80，95%置信区间[CI]＝0.65-0.98，P＝.03），但不增加症状性颅内出血的发生率（OR＝1.12，95% CI＝0.88-1.44，P＝.35）。在后循环卒亚组中，替罗非班显著降低了 3 个月死亡率（OR＝0.63，95% CI＝0.50-0.80，P＝.0001）和症状性颅内出血发生率（OR＝0.60，95% CI＝0.37-0.95，P＝.03）。对于有效性结局，在前循环卒亚组中，替罗非班显著改善了良好的功能结局（OR＝1.24，95% CI＝1.06-1.45，P＝.008），但不改善再通率（OR＝1.17，95% CI＝0.93-1.47，P＝.17）和优秀的功能结局（OR＝1.19，95% CI＝0.97-1.46，P＝.10）。在后循环卒亚组中，替罗非班显著提高了再通率（OR＝1.94，95% CI＝1.43-2.65，P＜.0001），但不改善良好的功能结局（OR＝1.03，95% CI＝0.81-1.30，P＝.81）和优秀的功能结局（OR＝0.84，95% CI＝0.58-1.20，P＝.34）。
在接受 EVT 的急性缺血性脑卒中患者中，替罗非班改善了前循环卒患者的良好功能结局，增加了后循环卒患者的再通率，降低了死亡率，且不增加症状性颅内出血的风险。替罗非班在前循环卒和后循环卒患者接受 EVT 时均安全有效。未来需要更多的大型多中心随机对照研究。
