Continuous intravenous tirofiban can improve the 90-day functional outcome and decrease 90-day mortality without increasing bleeding risk in acute ischemic stroke patients treated by endovascular therapy: A meta-analysis. (May 2022)

• Record Type: Journal Article
• Authors: Zhang, Aiwu; Wu, Nihong; Liu, Xintong; Jiang, Tao
• Is Part Of: Journal of clinical neuroscience. Volume 99(2022)
• Page Start: 109
• Page End: 116
• Publication Date: 2022-05
• Subjects: Acute ischemic stroke -- Tirofiban -- Intravenous -- Endovascular therapy -- Meta-analysis; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2022.03.008
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Intravenous tirofiban can significantly improve mortality and functional outcomes at 90 days. Intravenous tirofiban is safe, whatever monotherapy or combined intravenous with intra-arterial tirofiban. Mechanical thrombectomy can reduce mortality, but the outcome is not significant in ballooning or stenting. Abstract: Background: The role of continuous intravenous administration of tirofiban in endovascular therapy is still unclear. This meta-analysis aims to evaluate the 90-day functional prognosis in acute ischemic stroke patients (AIS) treated by endovascular treatment and intravenous administration of tirofiban. Methods: We searched PubMed, Embase, and CENTRAL databases with the subject terms "tirofiban", "brain ischemia", and some related free words. Inclusion criteria were: (1) cohort study or randomized control trials; (2) AIS patients who received endovascular therapy; (3) the intervention or exposure was intravenous tirofiban monotherapy or combined with intra-arterial tirofiban; (4) containing data on modified Rankin Scale at 90 days and including at least one of the following indicators: mortality, symptomatic intracranial hemorrhage (sICH), intracranial hemorrhage (ICH), and recanalization. A summary odds ratio was calculated. Results: Twelve eligible studies, consisting of 3268 AIS participants, were identified. There was a significant trend of favorable outcomes (measured by mRS at three months) in the tirofiban group (ORs = 1.36; 95% CI = 1.09–1.70). In addition, compared with the non-tirofiban group, intravenous tirofiban was significantly associated with decreased risk of 90-day mortality (ORs = 0.73; 95% CI:0.59–0.89) and increased recanalization rate (ORs = 1.50; 95% CI:1.08–2.09) but no significant difference in rates of sICH (ORs = 0.93; 95% CI = 0.70–1.24) or ICH (ORs = 0.84; 95% CI = 0.62–1.15). Conclusions: Intravenous tirofiban appears to be safe and effective when used following intra-arterial tirofiban or as monotherapy in AIS patients treated by endovascular therapy, which can improve the 90-day functional outcome, decrease the 90-day mortality and increase the possibility of early recanalization without increasing rates of sICH and ICH.