Tirofiban for acute ischemic stroke: systematic review and meta-analysis

Area of Science:

• Neurology
• Pharmacology
• Clinical Medicine

Background:

• The use of tirofiban in acute ischemic stroke (AIS) management is debated.
• Existing evidence on tirofiban's safety and efficacy in AIS requires comprehensive evaluation.

Purpose of the Study:

• To systematically review and meta-analyze the safety and efficacy of tirofiban for AIS patients.
• To assess the impact of tirofiban on key clinical outcomes including hemorrhage, mortality, and functional status.

Main Methods:

• A systematic literature search was conducted across major databases and trial registries up to March 2019.
• Included were randomized controlled trials (RCTs) and cohort studies comparing tirofiban with control for AIS.
• Primary outcomes: symptomatic intracranial hemorrhage (sICH), fatal ICH, mortality, and modified Rankin Scale (mRS 0-2) at 3 months.

Main Results:

• Seventeen studies with 2914 AIS patients were analyzed.
• Tirofiban did not significantly increase sICH or mortality.
• Fatal ICH risk was elevated with tirofiban, particularly with intra-arterial (IA) administration, but not with intravenous (IV) administration. Functional outcomes showed no significant improvement.

Conclusions:

• Systemic tirofiban administration appears safe for AIS management.
• Intra-arterial tirofiban requires further investigation to establish safe and effective protocols.
• Tirofiban may be a potential therapeutic option for AIS, pending further evidence on IA administration.