Tirofiban vs. aspirin in patients with acute ischemic stroke: A meta-analysis of randomized clinical trials

Antiplatelet therapy is recommended as the standard treatment for patients with acute ischemic stroke (AIS) who, for several reasons, did not receive thrombolysis or thrombectomy. However, whether tirofiban or aspirin provides greater benefits for these patients remains unclear. Therefore, we aimed to perform a meta-analysis comparing the functional outcomes and hemorrhagic risks associated with tirofiban and aspirin in the management of AIS.

We searched PubMed, EMBASE, Web of Science, and Cochrane Library for studies comparing tirofiban to aspirin in patients with AIS who did not receive thrombolysis or thrombectomy until September 2024. Outcomes were modified Rankin Scale (mRS) and mortality at 90 days, symptomatic intracranial hemorrhage, and any bleeding events. Statistical analysis was performed using the R Studio (version 2024.04.1+748).

We included 3 randomized controlled trials with a total of 1959 patients, of whom 996 (50.8 %) were in the tirofiban group. Excellent (mRS 0-1) functional outcome (RR 1.25, 95 % CI: 1.05-1.49; I² = 70 %) and favorable (mRS 0-2) functional outcome at 90 days (RR 1.09, 95 % CI: 1.01-1.16; I² = 35 %) were significantly higher in tirofiban compared to aspirin. Furthermore, tirofiban showed no difference in mortality (RR 0.77, 95 % CI: 0.24-2.53; I² = 56 %), or symptomatic intracranial hemorrhage (RR 3.42, 95 % CI: 0.27-43.30; I² = 38 %). However, any bleeding event (RR 1.75, 95 % CI: 1.25-2.45; I² = 0 %) was more common in the tirofiban group. Lastly, the meta-regression analysis showed that the outcomes were not influenced by the initial NIHSS of the included studies (p > 0.05).

Tirofiban is associated with better functional outcomes at 90 days, with no difference in mortality. Additionally, despite being associated with higher bleeding events, there is no difference in symptomatic intracranial hemorrhage. Therefore, our results suggest that tirofiban is a promising alternative to aspirin.