Alqurashi Shatha, Alqahtani Mohammed S, Albeladi Shahad Mohammed, Almahdawi Saleha, Danish Hala, Alshaikh Hatoon, Alkhiri Ahmed, Alkawi Ammar, Al-Ajlan Fahad S, Alhazzani Adel
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
Front Neurol. 2025 May 13;16:1552658. doi: 10.3389/fneur.2025.1552658. eCollection 2025.
Reperfusion treatments with intravenous thrombolysis and endovascular thrombectomy after acute ischemic stroke (AIS) can improve patients' outcomes significantly. Yet, a substantial portion of patients miss the opportunity to receive reperfusion treatments. In this study, we aimed to assess the role of intravenous tirofiban in this specific population.
A search was performed in Embase, Cochrane Central Register of Controlled Trials, Medline, and Web of Science databases from inception until August 2024. The random-effects model was used to calculate odds ratios (ORs) with their corresponding 95% confidence intervals (CIs). Efficacy endpoints included excellent (modified Rankin scale of 0-1) and good (modified Rankin scale of 0-2) functional outcomes at 90 days. Safety outcomes included symptomatic intracerebral hemorrhage (sICH), any ICH, and 90-day mortality.
Four randomized clinical trials, including a total of 1,199 patients, were included. Of these, 599 patients (50%) received tirofiban. The meta-analysis demonstrated that tirofiban was associated with significantly higher rates of both excellent (OR 1.63 [95% CI, 1.24-2.13]; I = 0) and good (OR 1.65 [95% CI, 1.19-2.29]; I = 0) functional outcomes at 90 days. No significant differences were observed in sICH, any ICH, or 90-days mortality.
Treatment with intravenous tirofiban can be beneficial without increased risk in patients with AIS who are not eligible for reperfusion treatment. Further studies are still needed to validate the generalizability of these findings.
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024590097, CRD42024590097.
急性缺血性卒中（AIS）后采用静脉溶栓和血管内血栓切除术进行再灌注治疗可显著改善患者预后。然而，相当一部分患者错失接受再灌注治疗的机会。在本研究中，我们旨在评估静脉注射替罗非班在这一特定人群中的作用。
检索了Embase、Cochrane对照试验中心注册库、Medline和Web of Science数据库，检索时间从各数据库建库至2024年8月。采用随机效应模型计算比值比（OR）及其相应的95%置信区间（CI）。疗效终点包括90天时的良好（改良Rankin量表评分为0 - 1）和优秀（改良Rankin量表评分为0 - 2）功能结局。安全性终点包括症状性脑出血（sICH）、任何脑出血以及90天死亡率。
纳入了4项随机临床试验，共1199例患者。其中，599例患者（50%）接受了替罗非班治疗。荟萃分析表明，替罗非班与90天时显著更高的良好（OR 1.63 [95% CI，1.24 - 2.13]；I = 0）和优秀（OR 1.65 [95% CI，1.19 - 2.29]；I = 0）功能结局发生率相关。在sICH、任何脑出血或90天死亡率方面未观察到显著差异。
对于不符合再灌注治疗条件的AIS患者，静脉注射替罗非班治疗可能有益且不会增加风险。仍需进一步研究以验证这些发现的普遍性。
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024590097，CRD42024590097。
