Yang Yonghong, Yang Qingwu
Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China.
Department of Neurology, Xinqiao Hospital Army Medical University,Chongqing 400037, China.
J Stroke Cerebrovasc Dis. 2025 Jan;34(1):108111. doi: 10.1016/j.jstrokecerebrovasdis.2024.108111. Epub 2024 Nov 3.
Tirofiban plus recombinant tissue plasminogen activator (rtPA) shows good efficacy and safety in treating acute ischemic stroke (AIS) patients, but there is a lack of comprehensive assessment. This meta-analysis aimed to compare the efficacy and safety of rtPA plus tirofiban with rtPA alone in AIS patients.
This meta-analysis retrieved studies comparing rtPA intravenous thrombolysis followed by tirofiban (rtPA+T group) versus rtPA intravenous thrombolysis alone (rtPA group) for AIS patients in Excerpt Medica Database, Web of Science, Cochrane, PubMed, China National Knowledge Infrastructure, Wanfang, and SinoMed until March 2024.
Twenty studies with 2048 AIS patients were enrolled in this meta-analysis. National Institute of Health stroke scale (NIHSS) score after treatment was lower in the rtPA+T group than the rtPA group [standardized mean differences (SMD)=-1.41; 95 % confidence interval (CI)=-1.83, -0.98; P<0.001]. The proportion of AIS patients achieving a favorable functional outcome (modified Rankin Scale score ≤2) was increased in the rtPA+T group versus the rtPA group [relative risk (RR)=1.13; 95 % CI=1.05, 1.21; P=0.001]. The incidence of re-occlusion was lower in the rtPA+T group than in the rtPA group (RR=0.24; 95 % CI=0.10, 0.59; P=0.002), but the incidence of intracranial hemorrhage (ICH) (RR=0.85; 95 % CI=0.51, 1.43), symptomatic ICH (RR=1.10; 95 % CI=0.43, 2.84), and mortality (RR=1.39; 95 % CI=0.53, 3.65) was not different between the two groups (all P>0.05). The stability assessed by sensitivity analysis was good, and no publication bias was found.
rtPA plus tirofiban achieves superior efficacy with comparable safety profiles compared to rtPA alone in AIS patients.
替罗非班联合重组组织型纤溶酶原激活剂（rtPA）在治疗急性缺血性卒中（AIS）患者中显示出良好的疗效和安全性，但缺乏全面评估。本荟萃分析旨在比较rtPA联合替罗非班与单纯rtPA治疗AIS患者的疗效和安全性。
本荟萃分析检索了截至2024年3月在医学文摘数据库、科学网、考克兰图书馆、PubMed、中国知网、万方和维普中比较rtPA静脉溶栓后使用替罗非班（rtPA+T组）与单纯rtPA静脉溶栓（rtPA组）治疗AIS患者的研究。
本荟萃分析纳入了20项研究，共2048例AIS患者。rtPA+T组治疗后的美国国立卫生研究院卒中量表（NIHSS）评分低于rtPA组[标准化均数差（SMD）=-1.41；95%置信区间（CI）=-1.83，-0.98；P<0.001]。与rtPA组相比，rtPA+T组AIS患者获得良好功能结局（改良Rankin量表评分≤2）的比例增加[相对危险度（RR）=1.13；95%CI=1.05，1.21；P=0.001]。rtPA+T组的再闭塞发生率低于rtPA组（RR=0.24；95%CI=0.10，0.59；P=0.002），但两组的颅内出血（ICH）发生率（RR=0.85；95%CI=0.51，1.43）、症状性ICH发生率（RR=1.10；95%CI=0.43，2.84）和死亡率（RR=1.39；95%CI=0.53，3.65）无差异（所有P>0.05）。敏感性分析评估的稳定性良好，未发现发表偏倚。
在AIS患者中，与单纯rtPA相比，rtPA联合替罗非班疗效更优，安全性相当。
