Federal University of Bahia, Salvador, Bahia, Brazil.
Federal University of Bahia, Salvador, Bahia, Brazil.
Clin Neurol Neurosurg. 2024 Dec;247:108626. doi: 10.1016/j.clineuro.2024.108626. Epub 2024 Oct 31.
Antiplatelet therapy is recommended as the standard treatment for patients with acute ischemic stroke (AIS) who, for several reasons, did not receive thrombolysis or thrombectomy. However, whether tirofiban or aspirin provides greater benefits for these patients remains unclear. Therefore, we aimed to perform a meta-analysis comparing the functional outcomes and hemorrhagic risks associated with tirofiban and aspirin in the management of AIS.
We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies comparing tirofiban to aspirin in patients with AIS who did not receive thrombolysis or thrombectomy until September 2024. Outcomes were modified Rankin Scale (mRS) and mortality at 90 days, symptomatic intracranial hemorrhage, and any bleeding events. Statistical analysis was performed using the R Studio (version 2024.04.1+748).
We included 3 randomized controlled trials with a total of 1959 patients, of whom 996 (50.8 %) were in the tirofiban group. Excellent (mRS 0-1) functional outcome (RR 1.25, 95 % CI: 1.05-1.49; I = 70 %) and favorable (mRS 0-2) functional outcome at 90 days (RR 1.09, 95 % CI: 1.01-1.16; I = 35 %) were significantly higher in tirofiban compared to aspirin. Furthermore, tirofiban showed no difference in mortality (RR 0.77, 95 % CI: 0.24-2.53; I = 56 %), or symptomatic intracranial hemorrhage (RR 3.42, 95 % CI: 0.27-43.30; I = 38 %). However, any bleeding event (RR 1.75, 95 % CI: 1.25-2.45; I = 0 %) was more common in the tirofiban group. Lastly, the meta-regression analysis showed that the outcomes were not influenced by the initial NIHSS of the included studies (p > 0.05).
Tirofiban is associated with better functional outcomes at 90 days, with no difference in mortality. Additionally, despite being associated with higher bleeding events, there is no difference in symptomatic intracranial hemorrhage. Therefore, our results suggest that tirofiban is a promising alternative to aspirin.
对于因多种原因未接受溶栓或取栓治疗的急性缺血性脑卒中（AIS）患者，抗血小板治疗被推荐为标准治疗方法。然而，替罗非班或阿司匹林在这类患者中的获益孰优孰劣仍不明确。因此，我们旨在进行一项荟萃分析，比较替罗非班和阿司匹林在未接受溶栓或取栓治疗的 AIS 患者中的治疗效果，主要评估指标为功能结局和出血风险。
我们检索了 PubMed、EMBASE、Web of Science 和 Cochrane Library 数据库，以获取截至 2024 年 9 月比较替罗非班和阿司匹林在未接受溶栓或取栓治疗的 AIS 患者中的疗效的研究。结局指标包括改良 Rankin 量表（mRS）评分和 90 天死亡率、症状性颅内出血和任何出血事件。统计分析使用 R Studio（版本 2024.04.1+748）进行。
我们共纳入了 3 项随机对照试验，共纳入了 1959 例患者，其中 996 例（50.8%）患者接受了替罗非班治疗。替罗非班组的功能结局较好（mRS 0-1）（RR 1.25，95%CI：1.05-1.49；I² = 70%）和功能结局良好（mRS 0-2）（RR 1.09，95%CI：1.01-1.16；I² = 35%）的患者比例明显高于阿司匹林组。此外，替罗非班组的死亡率（RR 0.77，95%CI：0.24-2.53；I² = 56%）或症状性颅内出血发生率（RR 3.42，95%CI：0.27-43.30；I² = 38%）与阿司匹林组无差异。然而，替罗非班组的任何出血事件（RR 1.75，95%CI：1.25-2.45；I² = 0%）发生率更高。最后，meta 回归分析表明，纳入研究的初始 NIHSS 不影响结局（p > 0.05）。
替罗非班在 90 天的功能结局方面更优，且死亡率无差异。此外，尽管替罗非班相关的出血事件发生率更高，但症状性颅内出血发生率无差异。因此，我们的研究结果表明替罗非班是阿司匹林的一种有前途的替代药物。
