Kamran Abdullah Bin, Khalil Ahmed Bazil Bin, Muhammad Ayesha, Arshad Hira, Nazir Fatima, Ali Muhammad Mateen, Umar M Mairaj, Farhan Muhammad, Alam Sudhair, Iqbal Javed
Rawalpindi Medical University, Rawalpindi, Pakistan.
Shaheed Mohtarma Benazir Bhutto Medical College, Lyari, Pakistan.
Brain Behav. 2025 Jun;15(6):e70508. doi: 10.1002/brb3.70508.
Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality globally. Standard antiplatelet therapies, while partially effective, do not fully inhibit all pathways of platelet aggregation, leaving patients at risk of recurrent thrombotic events. Tirofiban, a glycoprotein IIb/IIIa receptor inhibitor, has shown promise as an adjunctive treatment in AIS.
A comprehensive search was conducted in PubMed, ClinicalTrials.gov, and Cochrane library from inception to July 2024, following PRISMA guidelines. Inclusion criteria comprised randomized controlled trials (RCTs) and comparative observational studies where tirofiban was used as an adjunct to standard antiplatelet therapy. Primary outcomes included symptomatic intracranial hemorrhage (sICH) and favorable modified Rankin scale (mRS) scores at 90 days. Secondary outcomes included National Institute of Health Stroke Scale (NIHSS) scores and all-cause mortality. Data was analyzed using Review Manager v5.4.1, with random-effects models employed for all outcomes.
Fifteen studies, comprising 4,457 patients, were included. Tirofiban significantly improved the likelihood of achieving favorable mRS scores (OR 1.65, 95% CI [1.29, 2.11], p = 0.0001), with moderate heterogeneity (I = 57%, p = 0.006). Tirofiban also significantly reduced NIHSS scores (MD -2.08, 95% CI [-2.77, -1.39], p < 0.00001). There was no significant difference in the incidence of sICH between the tirofiban and control groups.
Tirofiban as an adjunct to standard antiplatelet therapy in AIS patients significantly improves functional outcomes and reduces neurological impairment without increasing the risk of sICH.
急性缺血性卒中（AIS）是全球发病和死亡的主要原因。标准抗血小板治疗虽有部分疗效，但不能完全抑制血小板聚集的所有途径，使患者有复发性血栓事件的风险。替罗非班是一种糖蛋白IIb/IIIa受体抑制剂，已显示出作为AIS辅助治疗的潜力。
按照PRISMA指南，从创刊至2024年7月在PubMed、ClinicalTrials.gov和Cochrane图书馆进行了全面检索。纳入标准包括将替罗非班用作标准抗血小板治疗辅助药物的随机对照试验（RCT）和比较观察性研究。主要结局包括90天时的症状性颅内出血（sICH）和改良Rankin量表（mRS）良好评分。次要结局包括美国国立卫生研究院卒中量表（NIHSS）评分和全因死亡率。使用Review Manager v5.4.1进行数据分析，所有结局均采用随机效应模型。
纳入15项研究，共4457例患者。替罗非班显著提高了获得良好mRS评分的可能性（OR 1.65，95%CI[1.29，2.11]，p = 0.0001），异质性中等（I² = 57%，p = 0.006）。替罗非班还显著降低了NIHSS评分（MD -2.08，95%CI[-2.77，-1.39]，p < 0.00001）。替罗非班组和对照组之间sICH的发生率没有显著差异。
在AIS患者中，替罗非班作为标准抗血小板治疗的辅助药物可显著改善功能结局并减少神经功能损害，而不会增加sICH的风险。
