Safety and Efficacy of Tirofiban During Intravenous Thrombolysis Bridging to Mechanical Thrombectomy for Acute Ischemic Stroke Patients: A Meta-Analysis

Abstract

IntroductionThe safety and efficacy of tirofiban in intravenous thrombolysis (IVT) bridging to mechanical thrombectomy in patients with acute ischemic stroke (AIS) is unknown. The purpose of this meta-analysis was to evaluate the safety and efficacy of tirofiban in IVT bridging to mechanical thrombectomy in acute ischemic stroke.MethodsWe systematically searched PubMed, EMBASE, Web of Science, and The Cochrane Library, CNKI, and Wan Fang databases for randomized controlled trials and observational studies (case-control studies and cohort studies) comparing the tirofiban and non-tirofiban groups in AIS intravenous thrombolysis bridging to mechanical thrombectomy (Published by November 20, 2021). Our primary safety endpoints were symptomatic cerebral hemorrhage (sICH), intracranial hemorrhage (ICH), postoperative re-occlusion, and 3-month mortality; the efficacy endpoints were 3-month favorable functional outcome (MRS ≤ 2) and successful recanalization rate (modified thrombolytic therapy in cerebral infarction (mTICI) 2b or 3).ResultsA total of 7 studies with 1,176 patients were included in this meta-analysis. A comprehensive analysis of the included literature showed that the difference between the tirofiban and non-tirofiban groups in terms of successful recanalization (OR = 1.19, 95% Cl [0.69, 2.03], p = 0.53, I2 = 22%) and favorable functional outcome at 3 months (OR = 1.13, 95% Cl [0.81, 1.60], p = 0.47, I2 = 17%) in patients with IVT bridging mechanical thrombectomy of AIS was not statistically significant. Also, the differences in the incidence of sICH (OR = 0.97, 95% Cl [0.58, 1.62], p = 0.89) and ICH (OR = 0.83, 95% Cl [0.55, 1.24], p = 0.36) between the two groups were not statistically significant. However, the use of tirofiban during IVT bridging mechanical thrombectomy reduced the rate of postoperative re-occlusion (OR = 0.36, 95% Cl [0.14, 0.91], p = 0.03) and mortality within 3 months (OR = 0.54, 95% Cl [0.33, 0.87], p = 0.01) in patients.ConclusionThe use of tirofiban during IVT bridging mechanical thrombectomy for AIS does not increase the risk of sICH and ICH in patients and reduces the risk of postoperative re-occlusion and mortality in patients within 3 months. However, this result needs to be further confirmed by additional large-sample, multicenter, prospective randomized controlled trials.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022297441.

Adjunct Intraarterial or Intravenous Tirofiban Versus No Tirofiban After Successful Recanalization of Basilar Artery Occlusion Stroke: The BASILAR Registry

“…Several studies reported that tirofiban could lead to neurological deterioration by increasing ICH risk, 19 and a meta‐analysis of 7 studies revealed that tirofiban was not associated with higher rate of ICH but trended toward lower mortality. 20 However, most of these studies did not report detailed information about the dose or the duration of intraarterial tirofiban in their cohorts. 16 , 19 , 20 A recent study from Guo et al illustrated that half of the patients receiving intravenous tirofiban were also treated with intraarterial local tirofiban in clinical practice in China, and simultaneous intraarterial+intravenous tirofiban rather than intravenous tirofiban improved outcomes of patients with anterior circulation stroke.…”

“… 20 However, most of these studies did not report detailed information about the dose or the duration of intraarterial tirofiban in their cohorts. 16 , 19 , 20 A recent study from Guo et al illustrated that half of the patients receiving intravenous tirofiban were also treated with intraarterial local tirofiban in clinical practice in China, and simultaneous intraarterial+intravenous tirofiban rather than intravenous tirofiban improved outcomes of patients with anterior circulation stroke. 16 In our preceding RESCUE‐BT trial, we found that intravenous tirofiban preceding thrombectomy failed to improve the clinical outcomes of patients with anterior circulation stroke.…”

Efficacy and safety of blood-activating herbs combined with edaravone in the treatment of acute ischemic stroke: A protocol for systematic review and meta-analysis

“…[3] Currently, effective treatments for ischemic stroke include early restoration of cerebral perfusion and salvage of the ischemic semidark zone. [4] Tissue-type fibrinogen activator (rt-PA, alteplase) is the only approved therapeutic agent for revascularization and improvement of neurological deficits. However, it is limited by the time window and the risks of hemorrhagic transformation and neurotoxicity, making it possible to benefit from it in only 2% to 5% of cases.…”

“…[3] Currently, effective treatments for ischemic stroke include early restoration of cerebral perfusion and salvage of the ischemic semidark zone. [4]…”

Advances in Neurological Diseases and Stroke

“…Unfortunately, there may be a failure of recanalisation or early re-occlusion. A meta-analysis of seven randomised controlled trials and observational studies involving 1175 patients given tirofiban, a GPIIb/IIIa receptor antagonist, or control, showed reduced peri-operative re-occlusion, but did not show better recanalisation or 3-month functional outcome, nor increased symptomatic intracranial haemorrhage (ICH) [ 14 ]. Cai et al performed a retrospective study of 285 patients who underwent thrombectomy for anterior circulation large artery occlusion, mean age 71 years, 61.7% female [ 15 ].…”