Efficacy and safety of intravenous tirofiban in patients with acute ischemic stroke due to large artery atherosclerosis undergoing endovascular thrombectomy: A systematic review and meta-analysis

Introduction: Intravenous tirofiban (IT) is shown to be potentially effective in acute ischemic stroke (AIS) patients submitted to mechanical thrombectomy, despite its safety and efficacy are not well established. However, there is a lack of evidence on the effects of IT on endovascular thrombectomy (EVT) in patients with AIS due to large artery atherosclerosis (LAA).

Objectives: To assess the safety and efficacy of IT in AIS patients due to LAA submitted to EVT.

Methods: Pubmed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases were systematically searched for studies that involved patients enrolled to take IT in AIS caused by LAA. The statistical analysis was performed using Risk Ratio (RR) with 95 % confidence intervals and the Mantel-Haenszel method of random-effects model to evaluate both efficacy and safety. Heterogeneity was assessed using I² statistics and Cochran Q test. This meta-analysis evaluated a modified Rankin scale (mRS) between 0 and 2, successful reperfusion, symptomatic intracranial hemorrhage (sICH), and mortality in 90 days. The statistical analyses for this study were performed using R software (version 4.4.1.) RESULTS: A total of 8 studies were analyzed, and a total of 2607 patients were included. In the meta-analysis, the IT group was associated with a higher proportion of patients in mRS 0-2 (RR 1.16; 95 % CI 1.04-1.29; I² = 0 %). There was no difference between the groups regarding successful reperfusion (RR 1.03; 95 % CI 0.98-1.09; I² = 64.2 %) and sICH (RR 0.83; 95 % CI 0.55-1.26; I² = 22.9 %), although tirofiban was associated with a lower mortality in 90 days (RR 0.70; 95 % CI 0.60-0.82; I² = 0 %).

Conclusion: This meta-analysis highlights the positive effects of adjuvant IT for AIS patients due to LAA submitted to EVT. It has been shown to improve functional outcomes and lower mortality rates in this population and to be a reliable medication in this setting.