Carretta Lucca Tamara Alves, Gonçalves Ocílio Ribeiro, Almeida Luiz Guilherme Silva, Souza Sandy, Fukunaga Christian, Bezerra Fernando Baía, Dos Santos Luiz Felipe Simões Antunes Nery, Teixeira Pedro Rodrigues, Andrade Ítalo Barros, Marques Fabrício Salazar Fiorio, Silva Yasmin Picanço, Noleto Gustavo
Department of Medicine, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória, Vitória, ES, Brazil.
Department of Medicine, Federal University of Piauí, Teresina, Piauí, Brazil.
J Thromb Thrombolysis. 2025 Jun 22. doi: 10.1007/s11239-025-03131-0.
Stroke is a leading cause of death and disability. Thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the primary treatment for acute ischemic stroke (AIS), but outcomes remain suboptimal. Eptifibatide, a glycoprotein IIb/IIIa inhibitor, has been explored as an adjunct to enhance reperfusion. This systematic review and meta-analysis assesses its effectiveness and safety compared to rt-PA alone. We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs). Primary outcomes included 90-day functional independence (modified Rankin Scale, mRS 0-1), mortality, and symptomatic intracranial hemorrhage (sICH). Meta-analyses used random-effects models to calculate Odds Ratios (ORs) with 95% confidence intervals (CIs). Heterogeneity was assessed with I². We included 988 patients from four RCTs. Eptifibatide was administered to 566 patients (57.3%). Adjuvant therapy did not significantly improved mRS 0-1 rates at 90 days (OR 1.12, 95% CI 0.60-2.09, p = 0.72, I²=74%) and did not reduce mortality (OR 1.55, 95% CI 0.92-2.61, p = 0.099, I²=0%). sICH was not statistically significantly different between the groups (OR 0.38, 95% CI 0.09-1.65, p = 0.196, I²=56%). Eptifibatide as an adjunct to rt-PA does not significantly impact functional independence, mortality, or sICH risk in AIS. Larger studies are needed to clarify its potential benefits and risks.
中风是导致死亡和残疾的主要原因。重组组织型纤溶酶原激活剂（rt-PA）溶栓是急性缺血性中风（AIS）的主要治疗方法，但治疗效果仍不尽人意。依替巴肽是一种糖蛋白IIb/IIIa抑制剂，已被探索作为增强再灌注的辅助药物。本系统评价和荟萃分析评估了其与单独使用rt-PA相比的有效性和安全性。我们在PubMed、Embase和Cochrane图书馆中检索了随机对照试验（RCT）。主要结局包括90天功能独立性（改良Rankin量表，mRS 0-1）、死亡率和症状性颅内出血（sICH）。荟萃分析使用随机效应模型计算比值比（OR）及95%置信区间（CI）。用I²评估异质性。我们纳入了来自四项RCT的988例患者。566例患者（57.3%）接受了依替巴肽治疗。辅助治疗在90天时未显著提高mRS 0-1率（OR 1.12，95%CI 0.60-2.09，p = 0.72，I²=74%），也未降低死亡率（OR 1.55，95%CI 0.92-2.61，p = 0.099，I²=0%）。两组间sICH无统计学显著差异（OR 0.38，95%CI 0.09-1.65，p = 0.196，I²=56%）。依替巴肽作为rt-PA的辅助药物对AIS患者的功能独立性、死亡率或sICH风险无显著影响。需要开展更大规模的研究以阐明其潜在的益处和风险。
